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sawn off. Profuse suppuration followed, formed. Rigors continued to recur, and he which so exhausted the patient's powers, that secondary amputation had to be performed on the 17th day. The man has done badly since the operation, and will probably die. Of the Leg.-Case 10. A man, aged 40, under Dr. Peacock's care, in St. Thomas's Hospital, for typhus fever, on the 10th day after admission, was attacked by gangrene of the left leg. A line of demarcation having formed, and his general condition appearing to warrant it, amputation below the knee was performed a month later by Mr. Simon. At the operation none of the vessels bled in the least, all the arteries appearing to be plugged; ligatures were, as a matter of precaution, placed upon the tibials.

rapidly sank; during the last few days jaundice was present. Death occurred on the 23d day. The autopsy showed pus in both knee-joints; pus beneath the whole course of the rectus femoris, lobular pneumonia, pleurisy, hepatitis, and enlargement of the glands of the small intestine. No phlebitis was discovered. Case 14. A man, aged 26, in excellent health, under the care of Mr. Lawrence, in St. Bartholomew's Hospital, had his leg amputated on account of distortion, resulting from an old injury, which, although for long quite healed, had left the member useless. The operation was done at his own request. During the first six days afterwards his condition was A large portion of the satisfactory; rigors, followed by profuse upper flap afterwards sloughed, and trouble-sweating, then set in, and death took place some abscesses formed. The man, how. on the 9th day. At the autopsy, pus was ever, improved somewhat in health, and at found in the anterior tibial vein, and secondone time hopes of recovery were entertain-ary deposits in the lungs and in one kidney. ed. A month after the operation gangrene Case 15. A man, aged 46, under the care attacked the opposite foot, and death fol- of Mr. Critchett, in the London Hospital, in lowed in a few days. At the post mortem, tolerably good health, but of irritable, dethe arteries and veins of the left leg were sponding temperament, had his right leg found plugged with fibrin to some distance amputated on account of epithelial cancer above the stump. There were also fibrin- of the foot. A considerable quantity of ous deposits in some of the internal organs. blood was lost at the operation. Severe Case 11. A man, aged 32, in Guy's Hos- rigors subsequently occurred, and all the pital, under the care of Mr. Hilton, for com- symptoms of pyæmia followed. Death took pound dislocation of the ankle-joint, with place on the 25th day. Pus was found in comminuted fracture. He was a healthy the knee joint, and secondary deposits in the liver. Of the Foot.-Case 16. A man, aged 19, in St. Mary's Hospital, under the care of Mr. Ure, on account of diseased tarsus. Mr. Ure removed the foot at the ankle-joint, leaving the posterior part of the os calcis. The stump is doing fairly. Of the Upper Extremity.-Case 17. A girl, aged 13, under the care of Mr. Tatum, in St. George's Hospital, on account of an unhealed burn, involving the elbow, and of three years' duration. She was in good health. Amputation through the upper performed, and she made a good Case 18. A boy, aged 14, ad

man.

Primary amputation in the upper third was performed, and, excepting some sloughing of the edges of the flaps, he has since done well. Case 12. An Irishman, in good health, aged 35, admitted into St. Bartholomew's Hospital, under the care of Mr. Lloyd, with severe compound fracture of both legs. Primary amputation by the circular method was performed on both, and the man has since done well, excepting a little sloughing of one of the stumps. He continues under treatment. Case 13. A man, aged 19, in excellent health, came up arm was from the country in order to have his left recovery. leg removed on account of very severe tali-mitted into Guy's Hospital, under the care pes varus, which prevented him from using of Mr. Cock, on account of a severe comit in walking. He was admitted under the pound fracture, involving the elbow-joint. care of Mr. Hilton, in Guy's Hospital; and, Primary amputation in the lower third of at his own urgent request, the amputation the upper arm was performed. Slight erywas performed. On the evening of the sipelas attacked the stump, but it notwithsame day he became feverish; on the next standing healed quickly, and the boy was day he had a rigor. A day or two later the discharged within the month. Case 19. A left knee joint began to swell, and subse- {healthy seaman, aged 59, under the care of quently a diffuse abscess in the thigh Mr. Birkett, in Guy's Hospital, on account

Excision of Bones and Joints.-None of the numerous cases in this class left under treatment by last month's report, can be recorded as recoveries; most of them are, however, doing well.

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of a severe compound fracture of the radius tongue. The cicatrix has already taken on and ulna. Secondary amputation through malignant action (before it was quite closed). the upper arm was performed on the fifth The patient is a man aged about 40. Case day, and he recovered well. Case 20. A3. By Mr. Cock, in Guy's Hospital, revery feeble man, aged 63, had amputation moval of a fungating mass, probably of soft in the upper third of the arm performed on cancer, from the scalp of a boy aged 14. In account of senile gangrene. The gangrene less than a month the disease grew again to had existed for six weeks previously, and its former bulk, and it has just been subhad limited itself by a line of demarcation jected to a second operation. Case 4. Exextending round the elbow. After the cision of the breast of a woman, aged 33, operation, a considerable part of the stump on account of scirrhus, by Mr. Johnson, united by adhesion, but on the seventh day in St. George's Hospital. Case 5. Exgangrene attacked the unhealed part, and cision of the breast of a woman, aged 42, death ensued on the day following. on account of scirrhus, by Mr. Johnson, in St. George's Hospital. Case 6. By Mr. Brooke, in the Westminster Hospital, exyetcision of almost the entire scrotum on account of chimney-sweep's cancer, in a man aged 50. There were no enlarged glands. The proper tunics of the testis were not injured, and the large wound is now healing well. Case 7. Excision of a scirrhous breast from a woman, aged 44, in good health, by Mr. Quain, in University College Hospital. The wound was healed and the patient has been discharged. Case 8. By Mr. Cock, in Guy's Hospital, removal by ligature of a tumour, supposed to be cancerous, from the labium of a woman, aged 65. The mass was the size of a walnut, projected considerably, but had no peduncle. It was easily circumscribed, and, a double ligature having been passed beneath its base, was strangulated in two halves. Recovered.

During the month there have been performed the following: Case 1. Removal of a small portion of exfoliated bone from the os calcis of a child aged 3 years, by Mr. Hilton, in Guy's Hospital. The posterior epiphysis of the bone is separated from its body, and it is probable that a second operation will be needed before the whole of the disease is removed. Case 2. A boy, aged 4, under the care of Mr. Birkett, in Guy's Hospital, for diseased elbow-joint, chiefly implicating the ulna. Mr. Birkett opened the joint and excised the olecranon. The child has since been dangerously ill, but is now fast improving. Case 3. Excision of the elbow-joint by Mr. Fergusson, in King's College Hospital. The patient, a lad aged 18, had suffered for eight months from disease of the joint; he has done well since the operation, and the parts are rapidly healing. Removal of Necrosed Bone.-Several operations of this class have been performed. Some of the more interesting we have already noticed, and none of the others re-covered or nearly so. During the month quire special mention. See Medical Times and Gazette for June 3.

Excision of Malignant Growths.-In Mr. Quain's case, previously mentioned, the ulcerated surface is almost healed.

Excision of Non-Malignant Growths.Mr. Cock's case of tumour in the pharynx remains under treatment by the chloride of zinc. In Mr. Coulson's case of cheloid (April, Case 1), the disease has reformed in the cicatrix of the wound. All the other cases mentioned last month are either re

there have been performed: Case 1. Excision of a cluster of scrofulous glands from the sub-maxillary region of a lad aged 16, by Mr. Hilton, in Guy's Hospital; recovered. Case 2. By Mr. Prescott Hewett, in During the month there have been per- St. George's Hospital, removal of a very formed: Case 1. By Mr. Fergusson, in large sebaceous tumour, of thirty years', King's College Hospital, excision of a me-growth, from the scalp of a woman aged dullary growth from beneath the clavicle. 63. There were many others. Some eryThe patient, a woman aged 48, had had a sipelas followed the operation, but the pamelanotic gland removed from her right grointient afterwards recovered well. Case 3. three years ago. Case 2. By Mr. Stanley, By Mr. Paget, in St. Bartholomew's Hosin St. Bartholomew's Hospital, excision of pital, excision of a very large epulis from an epithelial cancer from the side of the the upper jaw. The tumour was the size

hours afterwards. At the autopsy, a mass of medullary cancer was found extending downwards, and almost encircling the tra chea.

of half an orange, covered almost the whole moval of a cyst from under the scalp of a of the hard palate, and evered the upper child. This case is one of peculiar interest, lip. The patient was a woman aged 60. and we shall report it in detail shortly. The tumour had begun to grow twenty Several cases of minor importance, fatty, years ago, eight years after which, when fibrous, and encysted tumours, have been about half its ultimate size, it had been operated on, but do not require separate removed by operation. Mr. Paget cut mention. All the patients have done well. away the alveolar processes of the front Tracheotomy.-Case 1. In Guy's Hosteeth, to which the growth was firmly at-pital, by Mr. Hilton, for the removal of a tached, and then dissected the mass away foreign body from the larynx of a child. from the hard palate. The wound did well, The operation was completely successful, and the patient was soon discharged. Case and the child has left the hospital, the wound 4. By Mr. Birkett, in Guy's Hospital, re- being healed. We shall publish the details moval of a large epulis from the lower jaw. shortly. Case 2 By Mr. Humphrey (HouseThe patient was a strumous young woman, Surgeon), in St. Bartholomew's Hospital, aged 26, who had known of the disease for on a young woman, in whom suffocation about nine months. The growth extended appeared imminent, from the pressure of a along the right ramus of the jaw from the tumour of obscure nature in the front of the last molar to the first bicuspid, and had ex neck. Much temporary relief followed the panded the external wall of the bone out-operation, but the patient lived only eighteen wards. Its surface was ragged and fungating. Instead of removing the portion of bone from within which the diseased mass grew, Mr. Birkett enucleated the latter by means of the gouge. Examination with the Puncture of the Bladder.-In Mr. Simon's microscope, showed its structure to consist case, mentioned last month, a permanent of firm, fibrous tissue, with here and there fistula has been established above the pubes, bony spiculæ and cartilage, but no cancer- and the patient is quite out of danger from cells. The progress of the wound has the operation, by which he has been much hitherto been most satisfactory. Case 5. relieved. The cancerous growth by which By Mr. Birkett, in Guy's Hospital, re-the urethra had been obstructed now presses moval of a mammary glandular tumour on the rectum also, and it is contemplated from the breast of a woman aged 47. The to make an artificial anus in the loin in order tumour had been growing for two years, to prevent danger from this cause. During and one of similar character had been re-the month the operation has been performed moved from the opposite breast seven years by Mr. Hilton, in Guy's Hospital, under and a half ago. Recovered. Case 6. By the following circumstances: A man, aged Mr. Cock, in Guy's Hospital, removal of a 26, who had had a troublesome stricture for large fibro-cartilaginous tumour from the six years, was admitted, suffering from a right side of the neck of a woman aged 48. complete retention of twenty-four hours' It had been growing for many years, and duration. It was found impracticable to had attained the size of a very large fist. introduce a catheter; and, although the free Its attachments were very loose, and it was use of opium enabled him to pass a very very easily enucleated. The wound quickly small quantity of urine, yet the retention healed. Case 7. By Mr. Stanley, in St. was still so nearly complete, that on the Bartholomew's Hospital, excision, for a second day after admission, his state was fourth time, of a recurrent fibroid tumour one of great urgency. A trocar was now from the interscapular region of a girl aged passed into the bladder from the rectum. 11. The disease has, on each occasion, re- The canula was allowed to remain in the appeared in or near the cicatrix of the bowel for several days, and, after its withformer operation. The child has always drawal, the urine continued to pass by the recovered easily. Case 8. By Mr. Lloyd, wound for a day or two longer. In the in St. Bartholomew's Hospital, excision of mean time, however, the stricture had suffia large chronic mammary tumour, of nine ciently relaxed to allow of a moderately free years' duration. The patient was a healthy escape per urethram; and, when the man married woman, aged 41. Recovered. Case was discharged about a fortnight later, he 9. By Mr. Hilton, in Guy's Hospital, re- was in as comfortable a condition in this

respect as he had been for a long time, and an instrument of small size had also been passed through the stricture.

The patient

in King's College Hospital. had a stricture which would admit No 7, but which was very liable to contract, if not Removal of Impacted Calculus from the under constant treatment. An abscess havUrethra. The following case occurred ing formed between the bladder and recunder the care of Mr. Callaway, in Guy'sum, Mr. Fergusson took the opportunity, Hospital: A child, aged 2 years, was ad- when laying open, to perform also a mitted suffering from extravasation of urine perineal section of the stricture. The into the scrotum, perineum, etc., which was patient is thus far doing well. ascertained to have been the result of clos Ligature, etc., of Nævus.-Operations of ure of the urethra by an impacted calculus this class have been performed in cases reThe prepuce being enormously distended, spectively under the care of Mr. Fergusson, circumcision was first performed, and after- Mr. Cock, Mr. Hilton, Mr. Prescott Hew. wards Mr. Callaway was able, by means of ett, and Mr. Pollock. None of them require forceps, to extract the stone by the meatus, especial mention. A case of large aneurism from which it had not been far distant. To by anastomosis is under the care of Mr. prevent any further extravasation, a flexible Lawrence, in St. Bartholomew's, and has catheter was introduced, and left in. For been treated with partial success by means four days the child made great improve- of the ligature. We shall report its details ment, but on the fourth, owing to the in-at a future time.

strument having got stopped, a second Plastic Operations.-Mr. Erichsen's case, extravasation took place. The catheter mentioned last month, in which Syme's was now removed and replaced, and, to re-operation for fungous protrusion of the testis lieve the parts into which urine had been had been performed, has done well. The infiltrated, free incisions were made into the wound is healed, and the patient has been perineum. The child was extremely ill at discharged. In 7 cases operations for Harethe time this measure was adopted, and it lip have been successfully performed. In afterwards had the symptoms of peritonitis, 3 cases operations for the removal of defrom which it died three days later. At the formity from the cicatrices of burns have post mortem, the tissues around the neck of been performed, and remain under treatthe bladder and in the vesico-rectal foldment. were found in a sloughy condition, and the entire peritoneal surface was besmeared with soft, buttery lymph, apparently of very recent exudation. On a most careful examination no perforation of the peritoneum could be found.

In a case in St. Mary's Hospital, Mr. I. Baker Brown has performed his usual operation for ruptured perineum. A severe attack of erysipelas followed; and, although now subsided, has left the woman in a rather precarious condition. In a second case, Mr. Brown has operated for vaginal cystocele, and, as far as can yet be judged, with promise of a successful result.

Operation for Imperforate Anus.-On an

Operations for Urethral Stricture.-In Case 2, mentioned last month, the patient has died. Death took place about six weeks after the operation, and was caused appar-infant aged three days, in University College ently by exhaustion. The wound had not closed. No autopsy was permitted. Mr. Holt's patient (Case 1) is doing well; the external fistula is closing; the catheter is regularly used.

There have been performed during the month: Case 1. A man, aged 69, for six years the subject of stricture, admitted on account of extravasation of urine, which had been gradually increasing for ten days. A staff was passed down to the stricture and the latter divided. On account of the irritation it occasioned, a catheter could not be borne in the bladder subsequently. Death took place seventeen days after the operation. Case 2. By Mr. Fergusson,

Hospital, Mr. Quain performed an operation for imperforate rectum. The obstruction was about an inch and a half from the anus. It was opened by a trocar and canula, and remained patent for a week, when it reclosed. The operation was repeated, and a canula left in for some days. Since the last it has remained open for three weeks, but appears to be again contracting.

Tenotomy.-Mr. Paget's case, mentioned last month, continues under treatment. In several ordinary cases of talipes, the operation has been successfully performed. In a case of fracture of the leg, under Mr. Cock's care, in Guy's Hospital, it became necessary, on account of the difficulty of

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SKETCHES AND ILLUSTRATIONS OF MEDICAL QUACKERY.

keeping the parts in apposition, to divide the tendo-Achillis. The measure has been followed by good success.-Med. Times and Gaz. June 24, 1854.

SKETCHES AND ILLUSTRATIONS

OF MEDICAL QUACKERY.

this capacity, among other things, he does not hesitate to sign schedules of individuals applying to insurance companies, whose lives are insured on the faith of his representations. The validity of these insurances is, we believe, to be made the subject of another trial, and the mischief he may have occasioned in this way is yet to be ascertained. But this impostor, on the 8th ultimo, was tried at the Central Criminal Court in London for a misdemeanor, he "having uttered as true a false diploma of Edinburgh, entitling him to practise and assume the title of Doctor of Medicine.''

"It was undoubtedly an offence to utter a diploma like this, and persons should understand that if such a document was hung up in their houses where patients might see it, it was an uttering in law, and rendered them liable to the consequences. He could conceive cases where very great mischief might arise from an individual holding himself out falsely to be a physician. No man ought to trade upon a false bottom; and, undoubtedly, the fact of a person professing to have a diploma from the University of Edinburgh, where it was known that a very severe examination had to be undergone,

English Law and Quackery.-The extra ordinary decisions which the English courts of law so frequently present us with, when the subject of them in any way relates to the medical profession, is one of the great-The offence was distinctly proved; and est anomalies of the age. In most civilized "the jury, after a little hesitation, returned nations a medical practitioner is obliged to a verdict of Guilty, but with a strong rehold a diploma, which indicates that he has commendation to the merciful consideration - been educated for the profession, or that of the Court!"' Whereupon the Judge, his competency has been tested by an ex-(Mr. Baron Martin) gives utterance to the amination, and he who falsely assumes the following sage and indisputable remarks: title of doctor or surgeon is visited with summary punishment. Again, in most codes of law, culpable homicide is a crime; but what is culpable homicide, if it be not destroying life by administering powerful drugs, when unacquainted with their properties? Yet such is the absurdity of English law, that it has been proved over and over again, that if, for the purpose of gain, a deadly poison be so administered as to cause death, and the individual prescribing it plead ignorance of medicine, both judge and jury consider there is no harm done. But if a regularly educated medical practitioner commit a mistake, heavy dam-was calculated to give a man a position, and ages are awarded, and should malpraxis be followed by death, it is with the utmost difficulty he can escape the penalty of man- The learned Judge is then reported to slaughter. The result to be deduced from have passed sentence upon this man who he this state of things is, obviously, that it is could conceive might, by his gross fraud, safer in the eye of the English law to be commit great mischief, in the following ignorant than skilful, to impose on the pub- terms: "It was his intention on the prelic than serve them faithfully, to practise (sent occasion merely to pass a nominal the grossest quackery than exercise one's sentence, which was one of two days' improfession honourably. Need we be sur-prisonment; and the defendant under that prised that Charlatanism, under such cir- sentence would be entitled to his immediate cumstances, should flourish, and that the discharge; but he hoped the present propublic should at length look with indulgence {ceeding would have the effect of putting a on crimes which are not only not repressed, stop to such practices in future." but are positively encouraged by the state? Whether such a heavy sentence will proAnother singular illustration of this stateduce the effect the learned Judge anticipates of things has lately occurred. An indivi- may be much doubted; for, were not the dual named Lewis Bossy represents himself whole proceeding a melancholy truth, it as an M. D. of the University of Edinburgh, might well be regarded as a preposterous and hangs up a forged diploma in his sur-burlesque.

create a confidence, which no man ought to possess unless he was really entitled to it."

gery, to impose upon all and sundry. In In another case, where a man placed the

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