1854, charged with the manslaughter of Medical evidence was given, to the effect Mrs. Lambert, at Bradford. that the treatment described was improper and dangerous to life.

His Lordship said that, in his opinion, the treatment of the deceased must be so extravagantly wrong as to amount to mala fides; but it was a question for the jury to decide upon.

It appeared that the prisoner was a quack doctor, carrying on business in Wellington street, Leeds, and professing to cure cancer and similar disorders without the use of the knife. The deceased, having an incipient cancer, applied for advice to the prisoner, who attended her for twenty-eight weeks, Mr. Overend then addressed the jury for when she died; upon which an inquiry took the prisoner, and contended that the prisonplace before the coroner, and a verdict of man-er could not be convicted, unless it could slaughter against the prisoner was returned. be shown that he was either grossly or wilWilliam Lambert said-The deceased fully ignorant. Physicians and surgeons was my wife. In December, 1853, she had given opinions upon speculations which complained of a slight pain in the breast. had been formed upon the treatment which Dr. Field attended her, and my wife de- the deceased had received from the prisoner, clined having it cut. About the second for they were totally in the dark as to what week after Christmas we went to Leeds, to had been applied. The medical men themthe prisoner's house, where on the door, selves differed completely upon the mode of was a plate, "James Lawrence Ward, treating cancer, and the result was that if Curer of Cancer without the use of a Mr. Hey was right in his opinion, Mr. Field Knife." She showed the prisoner her ought to be convicted of manslaughter. breast, and he said, "It is a cancer." I There was nothing to show that the prisonasked if he could cure it, and he replied er had been guilty of gross ignorance, and that he could. I said I would publish it in he had used his best skill for the poor wothe papers if he did. He brought out a man, who had refused to have the knife small bottle, with a white powder, which used upon her. Before they could convict he put on a marble slab; then he put some the prisoner, they must be satisfied-first, black liquid from another bottle, and mixed that the prisoner had employed improper them together, and applied the liquid to my remedies; and secondly, that he was guilty wife's breast with a feather. It appeared to of gross negligence or gross ignorance, give her pain, as if it singed her, and as if which had not been established. it burnt her breast. He put a plaster on, and I paid him five shillings. We then left, and the week following she went to the prisoner again, and returned with a box of salve and pills. The third week we went again, and the prisoner put some white powder on the breast with some lint. This also gave her great pain. The prisoner said that she was going on very well. About this time her appetite failed, and she wasted away. We went to the prisoner for twenty-eight consecutive weeks, and paid five shillings each visit. The prisoner put on the liquid till it ate away the nipple and part of the breast, and the lump she complained of came away also. We then thought all was well, but the sore got worse. The prisoner then said he thought there was another cancer under the old sore. We went for seven weeks after the part of the breast had come away, and then a large lump arose which also came away, and then the prisoner said that he thought all would be right, but she got worse. I went to Dr. Field's for advice about a month before she died, which took place on the 4th of August last.

His Lordship, in summing up, said, that in order to substantiate the charge against the prisoner, it must be shown that he was guilty of such gross negligence, want of care, or ignorance, that he could not be said to be acting in good faith. The criminal law was not the mode of deciding doubtful points of medical law, and there was a remedy by action at law for want of skill; but when you endeavour to punish a medical man criminally, you must have as your criterion whether he acted bonâ fide. juries acted otherwise, they would have no scientific experiments made, which would be a great injury to the community; and consequently the rule should be very wide for the benefit of the medical profession themselves!!

If

The jury immediately returned a verdict of Not Guilty.

His Lordship then told the prisoner that after the medical testimony he had heard, he had better take care how he pursued his practice.-B. and F. Med. Chirurg. Review, July, 1855.

Statistical Report of the Principal Ope{numerous fragments have come away. Conrations performed in the London Hospitals, } siderable irritation has been caused, but on during the month of April, 1855.

Lithotomy.-Number of cases, 3; reco vered, 1; under treatment, 2.

the whole the man is doing well.

Ligature of Arteries.-Mr. Stanley's patient, in whom ligature of the femoral had been practised for popliteal aneurism, has been discharged. He is well in every respect, excepting that a collection of fluid of doubtful nature still remains in the aneurismal sac, and appears to be absorbing very He has for some time been allowed to take exercise. Mr. Cock's patient, in whom a like operation had been performed, has been discharged, under almost similar circumstances. The fluid in the sac was, however, diminishing more rapidly than in Mr. Stanley's case.

Case 1.-A man, aged 20, under the care of Mr. Lloyd, in St. Bartholomew's Hospital. The recto-urethral operation was performed, and a stone of considerable size removed. Doing well. Case 2.-A boy, aged 3, under the care of Mr. Lloyd, in St. { slowly. Bartholomew's Hospital. In this case, also, the recto urethral method was adopted. Do ing well. Case 3.-A boy, aged 9, under the care of Mr. James Lane in St. Mary's Hospital. A small mulberry calculus was removed by the usual lateral operation. Recovered.

Case 1.-A muscular drayman, aged 28, Lithotrity.-A man, aged 28, asthmatic, was admitted into St. Bartholomew's Hosand a bad subject for an operation, is under {pital, under the care of Mr. M'Whinnie, Mr. Hilton's care, in Guy's Hospital, with having had his left leg severely crushed bestone in the bladder. His symptoms dated tween his dray and a gate-post. The whole three years back, and he had suffered severe. {limb below the knee was swollen, tense, and ly. The bladder is very irritable, much { cold, and the swelling was said to have comcontracted, and has never been got to hold menced immediately after the accident.

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Four hours after admission the swelling had strangulated two days; symptoms not very much increased, more especially in the acute. The sac was not opened. Recovered. popliteal space. As no pulsation had been Case 3.-A woman, aged 33, under the care detected in either tibial artery, it was now of Mr. Erichsen, in University College Hos deemed probable that rupture of the main pital. Hernia femoral; strangulated seven trunk had occurred, and Mr. M'Whinnie hours; sac not opened. Recovered. Under accordingly determined to cut down into the Treatment.-Case 4.-A woman, aged 28, popliteal space and examine. The popliteal under the care of Mr. Spencer Smith, in St. and anterior tibial arteries were found on Mary's Hospital, the subject of femoral her exposure to be uninjured; but the dissection nia for six years. At the time of admission being continued downwards, it was ascer- the protrusion had been down twelve hours, tained that the posterior tibial, about an inch and there had been vomiting during that from its origin, was collapsed and pulseless. time. The bowels had, however, acted No laceration was discovered at the time; that morning under the influence of a dose but, as it was thought certain it must exist, of castor oil. Attempts at taxis proving intwo ligatures were applied, one below and effectual, the operation was at once perform. one above the spot where pulsation ceased. ed. The sac having been opened, a knuckle No bleeding occurred after the operation, but of much congested intestine was brought the patient sank, became delirious, and death into view. On the division of Gimbernat's took place on the day following. At the ligament an artery of some size was wound. post-mortem there was found, as had beened, and it became necessary to apply a liga. suspected, a laceration in the posterior tibial artery, just below the spot where the ligature had been applied. All the other vessels were sound. Case 2.-A man, aged 25, admitted into Guy's Hospital, under the care of Mr. Callaway, having injured his forearm by the bursting of a soda-water bottle. There had been profuse arterial hemorrhage from a wound just above the wrist. Mr. Callaway cut down upon and tied the radial artery at two parts, above and below a transverse injury, which had nearly divided its trunk. After this had been done, there seemed to be still bleeding from a branch near to the radial, supposed to be the superficialis volæ. This also was tied, and the bleeding then ceased. No tendons had been injured in the accident. The wound healed kindly.

ture to it. There were the symptoms of sharp peritonitis after the operation, but they subsided under treatment, and the patient is now doing well. Case 5.-A woman, aged 42, under the care of Mr. Ure, in St. Mary's Hospital, for years the subject of reducible femoral hernia. Strangulation had existed about nine hours at the time of the operation. Sac opened. An abscess formed after the operation above the posterior part of the crest of the ilium. Doing well. Deaths.-Case 6.-A woman, aged 57, under the care of Mr. Birkett, in Guy's Hospital. Hernia femoral; strangulated fifty-seven hours; sac opened. The bowel was actually inflamed, and almost gangrenous; but not so hopeless but that reduction was deemed warrantable. On the fourth day a fæcal fistula formed, and

Herniotomy.-Number of cases, 6; reco-death from exhaustion resulted on the fourvered, 2; under treatment, 3; died, 1 teenth. No autopsy was permitted. Amputations.

Of the Thigh..-Under

Recoveries.-Case 1-A man, aged 53, under the care of Mr. Hilton, in Guy's Hos-treatment.-Case 1.--A'man, aged 25, under pital, with a large inguinal hernia, which had the care of Mr. Hilton, in Guy's Hospital, on been strangulated eight hours. It was found account of necrosis of the tibia and disease of necessary to open the sac, but the stricture the knee-joint. He was the subject, also, of seemed to have been caused by a portion of diseased hip, on the same side. His health the fascia propria. A large mass of omen- was bad, and there were signs either of tum and a small coil of intestine occupied pneumonia or tubercular consolidation of a the sac; the latter was returned unseen. portion of one lung. He had been in the After the operation, the man had acute in-hospital for nearly nine months; and, as the flammation of the sac, and also some peritonitis. Under treatment, however, by calomel and opium, he made a good recovery. Case 2.-A woman, aged 40, under the care of Mr. Quain, in University College Hospital, hernia femoral, of very small size;

disease in the knee seemed to be rapidly exhausting him, it was thought best to remove the limb. The amputation was performed through the middle of the thigh. On the tenth day secondary hemorrhage occurred, and the stump had to be laid open,

Of the Upper Extremity.-Recovered.Case 9.-A healthy lad, aged 20, under the care of Mr. Fergusson, in King's College Hospital, on account of extensive laceration of the hand by machinery. An attempt was made to save it, but gangrene came on, and it was necessary to amputate through the forearm on the third day. Doing well. Case 10.-A labourer from the country was admitted into Guy's Hospital, under the care of Mr. Birkett, his right hand and wrist having been crushed in the wheels of a threshing machine. Primary amputation was performed. The stump healed by granulation, and was sound in about three weeks.

and a second ligature applied to the femoral replaced by bone almost as hard as ivory. artery, in which vessel an ulcerated opening The stump has done well, and is now healed, was found. The case is now doing well.excepting a single sinus, which depends upon Case 2.-A woman, aged 23, under Mr. a portion of bone which is dead, and will Hilton's care, in Guy's Hospital, on account have to exfoliate. of anchy losis of the knee-joint. The disease had existed for eighteen months, and had much reduced her health. Amputation by double flaps through the thigh. Doing well. Case 3.-A strumous boy, aged 3, under Mr. Hilton's care, in Guy's Hospital, with necrosis of the tibia and anchylosis of the knee-joint. Amputation through the thigh. Doing well. Case 4.-A boy, aged 12, weak and much emaciated, under the care of Mr. Gowland, in the London Hospital, on account of necrosis of the tibia and disease of the knee-joint. Flap amputation in the lower third was performed. Doing well. Case 5.-A man, aged 56, under the care of Mr. Hancock, in Charing Cross Hospital, Of the Foot.-Death.-Case 11.—A salon account of diseased knee-joint and ab- low-complexioned man, aged 27, under the scesses in the leg. His state of health at care of Mr. Fergusson, in King's College the time of the amputation was very bad, Hospital, on account of caries of the tarsal but he has borne it well, and is now progressbones, the result of an injury. Amputation ing favourably. Deaths.-Case 6.-A man, at the ankle joint was performed. After the aged 57, under the care of Mr. M' Whinnie, operation, extreme irritability of the stomach in St. Bartholomew's Hospital, for gangrene came, and violent sickness continued unin consequence of a severe crush of the leg. { checked nearly to the time of death, which He was only admitted on the fourth day, took place on the sixth day. The flap would when the mortification had already extended probably have sloughed, Under treatment. high up, and his state was extremely critical. A man, aged 56, under the care of Mr. Death followed twelve hours after the amputation. Case 7.—A man, aged 60, of very intemperate habits, was admitted into St. Mary's Hospital, under the care of Mr. Ure, having sustained a compound fracture of the femur in its lower third, with extensive laceration of the soft parts. He was intoxicated at the time of the accident, which had occurred six or seven hours previous to his admission. Primary amputation was performed. Gangrene afterwards attacked the stump, and death occurred on the fifth day. Of the Leg. Under treatment.-Case 8.A man, aged 44, under the care of Mr. Cock, in Guy's Hospital, on account of old stand. ing disease of the tarsus, for which several operations had been previously performed. He had been two years in the hospital, and, as the processes of repair proceeded very slowly, it was at length thought necessary to amputate. A double flap operation was performed in the middle third of the leg, the flaps being cut from without inwards. The tibia was found to have undergone extreme induration, its cancellous tissue having been

Cock, in Guy's Hospital, on account of disease of the ankle-joint of one year's standing. The skin over the heel was so much diseased, that the ordinary flap, in amputation at the ankle-joint, could not be obtained; Mr. Cock therefore dissected up the skin very freely from the front and outer part of the articulation. The lower surface of the tibia and the head of the fibula were sawn away. Considerable portions of the flaps sloughed, and the stump was, for the first week, in a very unhealthy condition; it has latterly, however, much improved, and it is hoped the result may yet be good.

Excision of Bones and Joints.-Several cases mentioned in previous reports remain under care. Mr. Statham's patient in the case of excision of the knee-joint, performed about nine months ago, has been discharged from the hospital. The sinuses are mostly healed, but she is still very weak, and unable to sit up. During the month the following have been performed: Case 1.-A strumous woman, aged 27, under the care of Mr Fergusson, in King's College Hos

ing for three years. On dissection, the bone was found occupied by cysts filled with gelatinous fluid, its external layer having been expanded until as thin as parchment. The patient has done well since the operation. Case 7.-A man, aged 55, under the care of Mr. Birkett, in Guy's Hospital, hav

pital, on account of diseased elbow-joint. as far forwards as the canine tooth on the A complete excision of the articulation was right side. The disease had been increasperformed, the H-shaped incision being adopted. Doing well. Case 3.-A stru mous child, aged 7, under the care of Mr. Hilton, in Guy's Hospital, on account of dis ease of the os calcis and astragalus. The os calsis was not actually necrosed, but was so extensively diseased that it became necessary to remove the whole of it. A semi-ing suffered from carious disease within the lunar flap was dissected up from the outer head of the tibia for five months. The side of the heel, and the os calcis, thus gouge was employed, and some softened exposed, was cut in two by bone forceps. cancellous bone infiltrated with pus was reThe periosteum, where it adhered, was next moved. The cavity seems to be filling up. carefully detached by the handle of the knife, Removal of Necrosed Bone.-Many cases and the two halves of the bone were easily of this class of operations remain under care removed. The under surface of the astra-in the different hospitals. In some, further galus being carious was gouged out. Hith-operative measures will be required at a erto the case promises well. It is hoped future time; others are likely to recover that, as the periosteum was carefully pre- without. served, there may be a considerable pro- The following have been performed during duction of new bone. Case 3.-A woman, the month: Case 1.-A boy, aged 11, unaged 25, under the care of Mr. Hilton, in der care in Guy's for necrosis of the right Guy's Hospital, on account of diseased os tibia. The disease had existed for three calcis. The skin was dissected up over the years. Mr. Hilton removed a very large affected spot, and the gouge freely applied. sequestrum, and it is believed all the affected The wound has healed, excepting a single portion. The wound has since been attacked fistula, which, it is feared, leads to bone yet by erysipelas, but is now healing. Case 2. in a state of disease; the inflammation not—A lad, aged 17, under Mr. Lane's care in improbably involving the articulation be-St. Mary's Hospital, having twice before had tween the astragalus and os calcis. Case 4. -An unhealthy man, aged 32, under the care of Mr. Stanley, for disease of the carpal bones. A semilunar flap was dissected up from the back of the hand, and most of the carpal bones, loosened and in a state of caries, taken out. Doing well. Case 5.A man, aged 52, under the care of Mr. Pa-upon diseased bone. The tibia was much get, in St. Bartholomew's Hospital, on account of old standing disease of the os calcis. In another hospital five operations with the gouge, trephine, etc., had been performed, but the remaining portion of bone still continued the diseased action. Mr. Pa-removal of the necrosed portions. This was get excised all that remained of the affected bone, and afterwards divided the tendoAchillis (subcutaneously) in order the better to permit of apposition. The wound made was, from the chronic thickening of the parts, etc. necessarily very large; but it progressed well, and the result seems likely to be favourable. Case 6.-A healthy man, aged 31, under the care of Mr. Fergusson, in King's College Hospital, on account of a tumour in the left side and front of the lower jaw. It was necessary to excise the bone from the anterior edge of the left masseter

necrosed bone removed from the humerus. A third operation has been performed. Doing well. Case 3.-A man, aged 38, under the care of Mr. Adams, in the London Hospital. He was in good health when admitted, but for twenty-eight years had suffered from an ulcer in front of the left tibia which depended

thickened about the part. Two attacks of mild hospital gangrene affected the wound, and caused delay of the operation. The tendency to phagedæna having, however, quite ceased, Mr. Adams proceeded to the

effected successfully, though not without some difficulty on account of the great thickness and density of the bone by which they were encased. Under treatment. Case 4. -A girl, aged 19, under the care of Mr. Birkett, in Guy's Hospital, on account of necrosis of a small part of the shaft of the ulna. The disease had existed four months. Erysipelas attacked the wound a few days after the removal of the sequestrum had been performed. Recovered.

Excision of Malignant Growths.-Case 1.-A man, aged 72, under Mr. Cock's care