hours; sac opened; a large quantity of tween the dura mater and cranium. The universally adherent omentum was found, dura mater was not injured, and the clot and concealed in it a small knuckle of in- having been with some difficulty removed, testine; the operation involved a very care- the symptoms of compression disappeared. ful and protracted dissection. Tympanitis On the following day, and throughout the came on afterwards, and death on the se- next week, the man was perfectly sensible, cond day resulted. At the post mortem, though somewhat drowsy. On the ninth only the indications of commencing perito-day erysipelas occurred, with rigors, and a nitis were found. Case 6.-A man, aged relapse into a state of coma. The dura 43, admitted almost moribund into the Mid-mater being tense, and bulging into the dlesex Hospital, under the care of Mr. wound, Mr. Adams punctured it, and let Shaw; strangulation four days; much out a large quantity of serous fluid, without, taxis; sac opened; bowel of deep red co- however, any relief. Death took place on lour, and ecchymosed, but not gangrenous; the fourteenth day, and the autopsy showed reduced, but some omentum left in the acute and general meningitis. sac; the omentum sloughed, and on its Ligature of Arteries,-A case is in St. separation fecal matter escaped; the man George's, under care of Mr. Johnson, in has had no peritonitis, and is doing as well which the femoral has been tied on account as can be expected. Case 7.-A man, aged of a punctured wound. The operation was 40, under Mr. De Morgan's care in the necessitated by recurring hemorrhage eighty Middlesex Hospital; a large scrotal tumour; hours after the accident. The man is doing strangulation 18 hours; sac opened; no-well; we shall probably publish the details thing but omentum found in sac; it was of his case at a future time. A second case ligatured and cut away; the man has re-is in St. Bartholomew's, under the care of covered well. In this case, although no Mr. Lawrence, in which a young man was intestine was involved in the hernia, yet the admitted six weeks after having received a symptoms of strangulation had been well deep wound between the first and second marked. Case 8.-A woman, aged 60, metacarpal bones. The bleeding had broken under the care of Mr. Wordsworth in the out again four days before admission, and London Hospital; femoral; strangulation continued afterwards to recur. Mr. Law. 40 hours; sac opened; favourable progress rence cut down and tied both ends of the under free use of stimulants. Case 9.-A radial artery at the wounded part. The woman of middle age, under the care of man is doing well. By Mr. Lloyd, in St. Mr. Lloyd in St. Bartholomew's Hospital; Bartholomew's Hospital. Ligature of the strangulation four days; sac opened; intes-radial artery, above and below a wound tine gangrenous; the intestine was opened, which had been inflicted by a piece of glass. and left in the wound, the stricture having The patient has done well. 'been divided over it; she lingered several days in a precarious condition, and then sank.

been admitted into St. Mary's, and are now being treated by compression.)

Aneurism.-Mr. Hilton's case of popliteal aneurism, in which compression is being pursued, remains under treatment, and alTrephining of the Skull.-A man was most in statu quo. (During the present admitted, insensible, into the London Hos-month two cases of popliteal aneurism have pital, under the care of Mr. Adams, having received a violent blow over the right temple. There was great swelling, but no Amputations.-The cases reported last wound. At first, the symptoms were those month, including the one in which phlebitis of concussion only, but twenty hours after- was suspected, may be considered convawards an epileptiform fit occurred, after lescent. There have been performed, durwhich, well-marked indications of compres-ing the month, 13 amputations-the subjects sion set in. Venesection to 3xxx. having of which are, 10 of them doing well, and 3 been practised without relief, Mr. Adams dead. Of these, five were amputations at cut through the scalp to expose the seat of the thigh for diseased knee-joint, by Messrs. injury. A fissure having been found ex- Lawrence, Fergusson, Hawkins, Tatum, tending in such a direction as to cross the and Simon. Mr. Fergusson's patient, a course of the middle meningeal artery, the young man, did well at first, but, after a trephine was applied, and some bone having time, was attacked by phlebitis, and died on been removed, a large clot was found be- ¿ the twenty-first day. The femoral vein was

found full of pus, and there was a small abscess in one lung. Mr. Hawkins's patient died apparently from exhaustion, a week after the amputation. The other three cases are recovered. Two cases of primary amputation of the leg, both performed by Mr. Ure in St. Mary's Hospital; one patient, an old man of 63, died from the shock of the severe accident he had sustained; the other is under care. One case of secondary amputation of the leg, recovered. One case of primary amputation of the arm, above the insertion of the deltoid, by Mr. Simon; the man has recovered well. Two cases of amputation at the ankle-joint, for diseased tarsus and for compound fracture; one by Mr. Fergusson, in King's; the other by Mr. Ure, in St. Mary's; both are doing well. One of Chopart's amputation, for diseased tarsus, by Mr. De Morgan, in the Middlesex; and another of amputation at the metatarso phalangeal joint, on account of compound fracture, by Mr. Lawrence, in St. Bartholomew's; both recovered. A man, whose leg had been amputated by Mr. Lloyd in St. Bartholomew's Hospital, and whose stump was so nearly healed that we had considered him convalescent, has died within the last week from prostatic abscess and gangrene of the penis. The cause of death had thus no connection with the operation.

those previously reported, their subjects continue under care.

Excision of Malignant Growths.--Four out of the six cases reported last month have recovered; the other two are doing favour. ably. During the month, one case of scirrhus of the mammary gland has been ope. rated on, with favourable result. One case of epithelial cancer of the prepuce. The patient in the latter was under the care of Mr. Moore, in the Middlesex Hospital He was 65 years old, and had perceived some induration of the prepuce for nearly a year, but there had existed a distinct tumour for only about a month. The glands in the groin were not indurated, and, the disease being quite in an early stage, the case was one very favourable for operation. The whole penis was amputated, and the wound soon healed. One case of very extensive epithelial cancer of the lower lip and integument of the chin, operated on in Guy's Hos{pital, by Mr. Hilton. The portion removed was very large, and, to close the wound, the adjacent skin had to be dissected up and united by means of harelip pins. The result was very successful, union by first intention occurring in almost the whole extent. A case of epithelial cancer of the lip, operated on by Mr. Lloyd, in St. Bartholo mew's Hospital, remains under care. University College Hospital, Mr. Quain Excision of Bones, Joints, etc.-The two has, in one case, extirpated the eyeball, on cases of excision of the wrist-joint, that of account of a tumour in the orbit, which, the head of the femur, and those also of from its progress, had appeared to be maligparts of the tarsus, previously reported, all {nant; under the microscope, however, it remain under care. In Mr. Fergusson's displayed only fibro-plastic characters. In wrist case, some more portions of the cari-St. Thomas's Hospital, Mr. Simon excised ous carpal bones have been removed. In part of the tongue of an elderly man, for a Guy's Hospital, Mr. Cock has operated, during the month, on two cases of diseased tarsus, removing large portions of bone; the patients are progressing favourably. In St. Thomas's, Mr. Clarke has performed the successful excision of a part of the upper maxilla on account of a malignant growth from the gum which adhered to the bone. Mr. Simon has removed the whole of a carious metacarpal bone of the thumb from a man who had suffered from disease about the part for five years. Mr. Partridge's case, of somewhat similar character, as also Mr. Hilton's, are still under treatment.

Removal of Necrosed Bone.-Eleven operations for the removal of dead bone (the long bones) have been performed during the month, and, together with seven of

In

very suspicious looking growth. Mr. Simon was afterwards, from the result of micro, {scopic examination, inclined to believe that it was warty, and not really cancerous.

Excision of Non-Malignant Tumours.With three exceptions, the cases previously reported are recovered. Seven operations have been performed during the month, all of them successfully. Two were for fibrocutaneous outgrowths from the labia; two for fatty tumours on the shoulder; one for epulis; one for sero-cystic tumour of the breast; one for an exostosis, the size of a pigeon's egg, from the border of the bicipital groove of the humerus.

Puncture of the Bladder.-This operation has been performed once during the month on account of impassable stricture. The

patient is in charge of Mr. Cock, in Guy's Hospital, and remains under treatment.

Operations for Urethral Stricture-The cases reported last month are still under treatment. In one case of impermeable stricture, in which, during the month, urethrotomy was performed, death resulted from subsequent peritonitis. In another, under the care of Mr. De Morgan, in the Middlesex Hospital, the operation of cutting down on the end of the sound just anterior to the stricture, with the intention of prolonging the incision into the proximal part of the urethra, was performed. Mr. De Morgan was not at the time successful in introducing an instrument, but he stated that he believed nevertheless that the obliterated part of the canal had been divided. The patient has done well, and a catheter has subsequently been passed through the whole urethra. The man had, on a previous occasion, had a similar operation performed in another hospital, and he had also had his bladder punctured by the rectum.

Paracentesis Thoracis.-The case in St. George's Hospital remains under treat ment, and the operation has again been per. formed.

Paracentesis Abdominis. - In Ascites four times, in all with relief. Ovarian Dropsy five times; one of the patients died of exhaustion afterwards; there was found at the autopsy a collection of multilocular cysts, in one of which suppuration was commencing.

Plastic Operations,-Mr. Quain's case of rhinoplasty has, after a small second operation, been discharged well. The other cases previously reported remain under care. Mr. Paget informs us, respecting the case on which three months ago he operated for a large urethral fistula, and apparently without success, that since the man left the hospital, the process of healing has gone on with so much of contraction, that the aperture is now nearly closed, and the man can at times pass urine through the whole length of the canal. Three cases of single harelip have been successfully operated on. In a case of cut throat, in which the wound remained open, Mr. De Morgan, in the Middlesex Hospital, performed the operation of paring the edges, and then uniting them by sutures; it has only partially suc ceeded.

Ligature of Varicose Veins -Mr. Erichsen has successfully treated a case of vari. cose veins of the leg in a woman, in University College Hospital, by the needle and twisted suture. No inconvenience attended the measure.

Employment of Galvanic Cautery.-The cases remain under care.

Neurotomy.-In King's College Hospital, on a patient who suffered from severe neu{ralgia, unrelieved by ordinary means, Mr. Bowman performed subcutaneous division of the trunks of the infra-orbital and of the mental branch of the inferior dental nerves. Very great relief has been afforded.

Ligature, etc. of Nævus -Operations for Operations for Cataract.-No extractions the cure of nævus have been performed in have been performed at the general hossix cases. In one, under the care of Mr.pitals during the month. The two cases Cock in Guy's Hospital, the injection of the undergoing treatment by absorption remain solution of perchloride of iron has been prac-under care.-Medical Times and Gazette, tised a second time, with the effect of ren- January 21, 1854. dering the tumour solid, and without any evil consequence. We leave the others, several of them of peculiar interest, for a future detailed report.

Fistula in Ano.-Four cases remain under treatment, and five operations have been performed during the month; all are doing favourably. In one, under the care of Mr. Cock in Guy's Hospital, stricture of the rectum also existed, and was divided at the same time that the fistula was laid open. Operations for the Cure of Ununited Fracture-The two cases in St. Bartholomew's Hospital are yet under treatment, and the result cannot in either be spoken of with certainty.

CHOLERA.

numerous relatives from other farms flocked in to see them, and many of these becoming infected were carried to their own houses, and were the means of spreading the disease in other places. So excessive, however, was the fear of the pestilence among the people of Tjörn, that at first, continues Dr. Ossbahr

"It was impossible for me to obtain at

among their nearest relations. At length, I succeeded in persuading a few, both men and women, to undertake this office; but, alas! after a few days, the best and the most active nurse, Anna Olsdotter, took the disease, and, still worse, she died!!

from Götheborg to Lofoen in the Skärgård; he recovered, but his wife and mother both took the disease and died. The persons who placed the deceased in their coffins carried the malady to another island, Brattö, and from thence it passed to the mainland adjoining. The parish of Ucklum remained free from cholera till the end of October, when a labourer, Nils Magnusson, returned home from the Saetter, or hill pastures attendants to wait upon the sick, except Ström, where several persons had already died of the disorder. Nils recovered, but four persons in his house took the disease, of whom two died. A young woman who attended on these last, sickened and died, and was shortly after followed by her father, who had nursed her in her illness. A la. bourer, who lived in the house of the last named person, died at a cottage about six English miles off, when the cottager next took the disease, and died on the same day. It is observed in the Report, that none but those who had communication with the infected suffered from cholera. No precautionary measures were adopted in this district, or in the greater part of the neighbour-where obtain the requisite attendance on the hood of Götheborg.

The island of Tjörn is separated from the mainland of Sweden by a narrow sound. Great alarm was felt by the inhabitants when the disease appeared at Götheborg, but their measures of precaution seem to have been lamentably deficient.

"When I first arrived on the island (November 30), I earnestly entreated the authorities not to permit the healthy and the diseased to remain in the same chamber. This, however, was neglected, or no measures were taken to enforce obedience. During the first days of my residence in Tjörn, the doors of the infected houses were constantly closed to me, nor could I any.

sick; but no inhabitant ever hesitated to attend the funerals of the cholera victims, where brandy, with camphor dissolved therein, was swallowed in immense quantities." (p. 194.)

As to the mode in which the disorder was introduced, Dr. Ossbalır's report is at va

The latter assert that not one out of at least 100 individuals who visited Götheborg, while the cholera raged in that town, were affected with the disease either there or on their return to Tjörn. Dr. Ossbahr tells us a very different story, without, however, directly contradicting the above assertion :

The reports of the district physician, Dr.riance with that of the local authorities. Ossbahr, plainly show that the inhabitants of Tjörn really exposed themselves in every way to the pestilence, and that they were in such a condition, as regards their customs and their habits, as pre-eminently to favour the progress of cholera. The mortality in Tjörn seems to have much exceeded the usual average. Out of 51 cases 20 deaths are recorded.

"From what I ascertained in Tjörn, a man of the name of Rutger Jonasson, a son

Jonas Pehrsson, in Aseby, had visited Götheborg on the 6th of November, and had there purchased various articles of clothing which had belonged to persons there dead of cholera. These clothes were made up into a bundle by Jonasson, and were brought by him direct to Aseby, where he placed the bundle in a chest, and allowed it to remain there for eight or ten days. One day, when a number of his relatives were assembled at Aseby, the bundle was taken out by Jonasson, with the remark that, 'the things had now lain-by so long that there could be no danger of infection,'

In Aseby, where the disorder first appear-of ed, the greater part of the inhabitants were attacked, and only three recovered. It was observed too on the other farms, that most of the cases occurred in one or two houses or families. The excessive mortality in Aseby is ascribed by Dr. Ossbahr to the circumstances that three families, which had before inhabited separate chambers, all, upon occasion of the first death from cholera, crowded themselves into a single room, wherein children and adults, the diseased and the healthy, continued to reside in the most extreme misery and filth. Moreover,

and he accordingly offered the articles of At the Falls of Trollhätta, there is a conclothing for sale. The clothes were handled and examined by those present, and purchased by some. The day after (Novem-deaths. ber 16), Jacob Christiansson, a man of 76 years of age, and one of those who had been present at Jonasson's house on the above occasion, was attacked with cholera, and one after another, all who had been there on the 15th, to the number of six individuals, fell victims to the disorder." (p. 195.)

The parish of Quille lies 30 or 40 English miles to the north of Tjörn, and no case of cholera had occurred in the intervening district. The disease here broke out on the 17th of November, shortly after the arrival of three boatmen from the infected district of Wenersborg.

siderable population of 1,400 to 1,500 souls. Here 96 cases of cholera occurred with 43 The causes of this high mortality are best given in the words of the report:"Unhealthy and crowded dwellings, want and intemperance, greatly increased the number of victims; and it was observed that the malady was peculiarly severe in those families where many individuals resided in one or two small rooms; while, when cholera did appear among the better classes, it seldom spread to the rest of the household, especially where the dwellings were large, airy, and well kept. Two old persons, man and wife, who lived about an English mile from Stafvered, but were not known to have had any communication with infected persons, were attacked with In Lilla Edet, on the left bank of the the disease almost at the same hour, and Götha Elv, about 120 cases occurred, nearly both soon died. A woman, aged 30, who one-half of which proved fatal. Here, as in attended them, took ill two days after at her other places, it was remarked that many own house, but gradually recovered; while persons whose bowels had been habitually her aged parents, residing in the same constipated for years, became perfectly re-dwelling, fell victims to cholera after about gular in their evacuations during the pre-a day's indisposition. A boy of 6 years of valence of cholera, but when the pestilence age lived also in the same room, but on the ceased, their bowels again became inactive.death of the old people and the illness of Of four nurses employed at Lilla Edet, their daughter, he was sent home to his two were affected with cholera. The dis-father, who resided in a wretched cottage ease was perhaps more widely spread in this at Stafvered. On the day of his arrival district, from the circumstance of its in- there he sickened and died; directly afterhabitants being mainly employed on the wards a girl in the same house was attacked "Ströms" Canal, which is cut through the and soon expired; and two children were rocks from the Wener Lake to the Gotha likewise affected, but recovered. Many of River, to avoid the Falls of Trollhätta. The the nurses who tended patients in some of amount of commerce on the Ströms Canal the more remote and more wretched tenemay be inferred from the fact, that fromments, were carried off by cholera." (p. the 20th of September to the 29th of October, 1850, 562 vessels passed through the sluices at Trollhätta, and in many of these, in their voyage up the river from Götheborg, cholera had appeared. The people of Lilla Edet were therefore in constant communi-son Andrew, who was working there. On cation with ships and with individuals coming from the infected district of Götheborg. In the parish of Asbräcka, the first case of cholera was that of Peter Andersson, who had visited his brother, Andrew, in the parish of Fuxerna (8 or 10 English miles off), while the latter was labouring under the disease. Peter Andersson sickened in his brother's house, was brought home to his own cottage, and there died. Five more of his household took the disease, of whom three died. Of his whole family the widow alone survived.

219.)

The first case of cholera in Skepplands parish occurred in the person of Anders Jonasson, who, on the 29th of September, had visited Götheborg, to bring home his

the 1st of October, this son was attacked with diarrhoea, vomiting, and cramps. In the night of the 3d of October, the father was seized with the like symptoms, and died on the 4th, at two in the morning. Another son, Hans, sickened on the 6th, and died on the following day.

At Wenersborg, a few miles above the Falls of Trollhätta, the Götha Elv flows out of the great inland lake of the Wenersee.

The tide of commerce from Götheborg, which has hitherto been confined to the limits of the Götha River, here spreads