very.

Case

3. St. Bartholomew's, Mr. Stanley. A girl, aged 15, in delicate health, for twelve years the subject of disease of the left knee.

The usual elliptical incision was practised, and the ends of the bones sawn away. The patella was allowed to remain and the hamstring tendons were not divided. Great retraction followed the operation, and it was found impossible to keep the parts in proper position. The suppuration was very profuse, but the girl kept up fairly. The displacement was so great, that it was at length de

ture six weeks before. Amputation through {in evidences of reparative action. No puruforearm. Recovery. Case 22. St. George's, lent deposits were found in the body. Mr. Cutler. A man, aged 42, in good health. Primary amputation through the upper arm, on account of compound fracture and dislocation of the elbow-joint. Reco-joint. She had been able to walk upon the Case 23. The Dreadnought, Mr. affected limb until about sixteen months Busk. A man, aged 23. Secondary am- before, when a fresh inflammation occurred, putation of the shoulder-joint four days after and since which the leg had been retracted a severe compound fracture of the humerus, and quite useless. Issues over the part, on which mortification had ensued. There and confinement of the limb in splints, had were other injuries inflicted. Under treat-been tried without benefit. On March 29, ment. Case 24. Guy's, Mr. Poland. A Mr. Stanley performed excision of the joint. lad, aged 15, in good health. Primary amputation of the hand just above the carpal bones, on account of compound fracture. Recovery. Case 25. Guy's, Mr. Callaway.{ A lad, aged 15, in good health, admitted on account of crushed hand. Phlegmonous erysipelas followed, and amputation through the forearm was performed six weeks after the accident. Recovered. Excision of Joints.-Case 1. Universitytermined to amputate. Circular amputation College, Mr. Erichsen. A man, aged 21, through the lower third of the thigh was for three years the subject of diseased knee- performed on April 10 (six weeks after the joint. The joint was opened by the usual excision), and she afterwards did remarkelliptical incision, and the articular extremi-ably well. Recovered. Case 4. St. ties of both bones sawn away, the patella George's, Mr. Cutler. A boy, aged 16, being left. Doing well. Case 2. The the subject of chronic disease of the kneeWestminster, Mr. Holt. A woman, aged joint. The joint was exposed in the usual 46, the subject of diseased knee-joint for way, and the end of the femur sawn off. three years. She was hectic, and much The tibia and patella were but very slightly reduced by long-continued suppuration. affected, and the carious spots in them Numerous sinuses existed. There was having been gouged away, they were not distinct grating of the bones on motion; interfered with further. Under treatment, the knee was flexed, but there was no Case 5. King's College, Mr. Fergusson. A anchylosis. The elliptical incision was woman, aged 18, under care on account of made, and the ends of the bones sawn away. diseased knee-joint, of two years' duration. The diseased part of the patella was gouged No benefit having been obtained by a six out, and the rest of the bone allowed to re-weeks' treatment by blisters and rest, excimain. All the cartilages were found to sion of the joint was performed. An H. have been removed, and the crucial liga-shaped incision was practised, and threements had also been destroyed. The ham-quarters of an inch in length from the femur, string-tendons were divided; a sinus al- and an inch from the tibia, were sawn away. ready existing into the popliteal space; no The carious portion of the patella was reother opening was needed. Not the least moved by the gouge. The synovial mem. difficulty was encountered afterwards in brane of the joint was found rough and keeping the limb at rest in the straight thickened; the cartilage was separated position. Profuse suppuration followed, from the surface of the tibia, and an abscess attended with diarrhoea and some cough; a extended an inch and a half into the centre large bed sore also formed, and from the of that bone. The limb was placed in the combined influence of these the patient sank. extended position on a straight iron splint. Death took place on the fifteenth day. No The patient suffered somewhat severely rigor had occurred. At the autopsy, the from the shock, but afterwards went on granulations about the wound seemed most satisfactorily. The greater part of healthy, but the cut surfaces of the bones the wound is now healed, and the bones are were of a greenish colour and quite wanting consolidating. Case 6. King's College, Mr.

been performed in seven cases. In three the lower jaw was the affected bone, in one the femur, in one the ilium, in one the radius, and in one the tibia. In none did any ill consequences result.

Fergusson. A man, aged 21, under care on account of diseased carpus. An incision was made over the part, and some fragments of carious bone removed. Under treatment. Case 7. The Middlesex, Mr. Shaw. A man, aged 18, for six months the subject of Operations for Urethral Stricture.-Case diseased hip-joint. The head of the femur 1. St. Bartholomew's, Mr. Paget. A man, was dislocated on to the dorsum ilii, and of middle age, under care on account of lay immediately beneath the skin, keeping stricture, the result of gonorrhea seventeen up much irritation. Excision of the head years ago. For six years past the stricture and neck of the bone was performed. The had caused much suffering, and there were acetabulum was found to be denuded of three or four fistulous passages in the scrocartilage, but not in a state of active disease. { tum, through which urine escaped. With No difficulty was afterwards encountered some difficulty a No. 1 groove staff was in keeping the thigh in position. The pa- passed through the stricture, and on it peritient's health has considerably improved neal section was performed. A silver casince the operation, but the wound still dis- theter was afterwards retained. The case charges. (The part removed was shown at did well. The wound is now nearly healed, a recent meeting of the Pathological Society. and only a little urine occasionally escapes See report, Med. Times and Gaz., p. 395.) from one of the fistulous passages. Case 2. Case 8. The Middlesex, Mr. Moore. A The Metropolitan Free, Mr. Hutchinson. woman, aged 31, for two years the subject { A man, aged 40, the subject of stricture for of diseased elbow-joint. The disease had thirty-four years, consequent originally on a begun without known cause, as stiffness, blow, and at different periods since much soon afterwards followed by abscesses. aggravated by attacks of gonorrhea. He Excision of the joint was performed. Ahad been under treatment in many hospitals, V-shaped portion was cut away from the and once or twice had very nearly died from humerus, so as to include almost the whole abscesses in the perineum and extravasation articulating surface, but to leave the con-of urine. No instrument had ever been got dyles. The extremities of the radius and into the bladder since 1849, although he ulna were cut away. A few days after the had in the interval had repeated attempts operation, a slight attack of erysipelas oc- made. He was admitted under Mr. Hutchincurred, but it soon subsided, and healing son's care on April 6, suffering from retenwent on well until, about six weeks later, ation, and after most patient trials it was fresh attack of unhealthy inflammation oc- found impracticable to introduce the smallest curred. Since the last there has been pro-catheter. Under the influence of opium a fuse suppuration. Under treatment. Case partial relaxation of the stricture took place, 9. University College, Mr. Erichsen. Aand some urine flowed. On the next day, child, aged 5, under care on account of dis- the bladder being still full, he was put under ease of the ulna and elbow-joint. Excision chloroform, and a No. Syme's staff having of the joint. Under treatment. Case 10. been forced through the stricture, perineal Guy's, Mr. Cock. A boy, aged 12, of section was performed. A No. 8 silver strumous constitution, thin, and cachectic. catheter was subsequently retained for He had long been the subject of diseased twelve hours. All went on well, and he left tarsus, and great thickening of the soft parts the hospital three weeks after, passing urine around the os calcis existed, several sinuses in a full stream, the wound in the perineum leading down to denuded bone. Mr. Cock being, however, not quite closed. A fortmade a free incision over the outer part of night later a calculus escaped from the bladthe bone, and took out almost the whole of der, and got impacted just anterior to the it, in a necrosed state. The dead portion prostate, for the removal of which a rather was quite detached, and was surrounded by free incision in the perineum had to be a good shell of new bone. But little flat-made. The man has now quite regained tening of the heel has resulted, and the parts are now almost healed.

Operations for the Removal of Necrosed Bone.-Operations for the removal of sequestra from necrosis of long bones have

his health, and the wound is very nearly healed. Case 3. Guy's, Mr. Birkett. A boy, aged 14, was admitted in January, having received a blow on the perineum, by which, as was proved by an incision,

the urethra had been torn completely across. rous fistulæ remained. No instrument could After recovery nearly the whole of the urine be introduced, and the operation performed passed by the perineal fistula which resulted. consisted in opening the urethra behind the On April 15, Mr. Birkett attempted to re- seat of disease The wound remains open. store the continuity of the canal by intro. The man is somewhat improved in health. ducing a catheter down to the contracted Puncture of the Bladder.- Case 1. Guy's, part, and having divided the latter, passing Mr. Birkett. A strong, healthy man, aged it on into the bladder. The instrument was 80, admitted with retention of urine of two retained for some days. The urine now days' standing. All attempts at catheterism mostly passes by the urethra, but the peri- failed. Opium was tried; but the sympneal wound is not yet closed. Case 4. The toms being urgent there was no time for Marylebone, Mr. Henry Thompson. A delay. Puncture of the bladder by the recman, aged 44, who had been under much tum was performed, and about three pints hospital treatment on account of a stricture of dark, turbid urine drawn off. The canula of twenty years' standing. Dilatation had got displaced forty hours after its introduc. been frequently resorted to, and with only {tion, and was removed. For a few days very temporary benefit. A No. 2 Syme's staff having been introduced, the stricture was freely divided from the perineum. A No. 10 catheter was retained for forty-eight hours. A month after the operation a No. 11 could be passed with ease, and the wound subsequently healed soundly. He passes urine in a good stream, and has quite re-from stricture, consequent on a blow, since gained his health. Case 5. King's College, the age of 9. Catheterism being impracti Mr. Fergusson. A man, aged 23, the stric- cable the bladder was punctured by the ture of eleven years' duration, and the result rectum. About two pints came away at the of a blow. Ferineal section was performed. time, but none flowed afterwards. Death Under treatment. Case 6. The Dread- took place the next day. The autopsy nought, Mr. Busk. A man, aged 27, suf- showed the bladder almost full of coagula. fering from numerous urinary fistula, conse- The kidneys were extensively atrophied quent on an impassable stricture of four years' from old disease. A long tract of the ureduration. The stricture was divided by inci-thra was all but impervious.-Med. Times sion from the perineum (without a staff), and {and Gazette, June 17, 1856.

urine continued to flow by the wound, but subsequently the natural channel became patent, and the wound closed. He left the hospital well one month after admission. Case 2. St. Bartholomew's, Mr. Skey. A man, aged 32, was admitted, almost dying, from retention of urine. He had suffered

MEDICAL NEWS.

DOMESTIC INTELLIGENCE.

a catheter passed into the bladder. Under treatment. Case 7. University College, Mr. Erichsen. A man, aged 35, the subject of several old fistula and a very tight stricture. Perineal section was performed. Doing well. Case 8. Guy's, Mr. Cock. A man, aged 28, in poor health; stricture of six years' duration, and for a long time impas. Suit for Malpractice.— [We invite attensable. The patient being on the operating {tion to the following report of a suit for maltable, and under the influence of chloroform, practice recently tried in New York, which Mr. Cock succeeded in introducing a small is remarkable from the circumstance of a grooved staff, on which perineal section was quack having met with his just deserts:-] at once performed. A No. 7 elastic cathe- MARINE COURT.-Before Judge Maynard. ter was retained for two days, and after--Courtney vs. Henderson.-The plaintiff wards passed occasionally. The wound is 57 years of age, of good habits, has worked healed quickly, and he now passes urine in as foreman for ten years for Messrs. Pollard, a good stream; there appears, however, to up to last December, when he quit with bad be a urethral pouch just below the diseased eyes; went to the Eye Infirmary; remained tract in which urine accumulates. Case 9. there from six to eight weeks, when he was Guy's, Mr. Cock. A man, aged 54, for induced by a friend of the defendant to leave twenty five years the subject of stricture. the Eye Infirmary and put himself under Extensive sloughing had destroyed a con- the defendant's treatment. There had been siderable portion of the urethra, and nume- a gradual improvement of his eyes from

soon after he entered the Eye Infirmary words, a person attempting to practice, in until he left, and that improvement con-physic or surgery, without first having obtinued for two or three weeks after he left-tained a knowledge of such science, is liable no doubt being the result of the treatment for all the damage that is the result of his he received at the Eye Infirmary-when practice. I have no doubt the plaintiff lost they began to grow worse. He continued his vision through the defendant's treatunder the defendant's treatment until July ment, and that the treatment was the result (about three months), and the defendant of ignorance on his part. Judgment for the performed an operation on his eyes, and put plaintiff, $500; allowance, &c., $12. some kind of a powder into them.

When he first put himself under the defendant's treatment he could go there alone; he soon became so blind that he had to be led there by a little boy. The plaintiff returned to the Eye Infirmary in July, but his vision was gone, never to return. Dr. Agnew deposed that he has no doubt the plaintiff's eyes would have got well if he had remained in the Eye Infirmary, or been under good treatment outside. Dr. Agnew and Dr. Buck, both holding positions in the Eye Infirmary-the only physicians who testified in relation to the treatment-have no doubt that the plaintiff's eyes would have recovered under proper treatment.

Medical Education in St. Louis.— [We commend the following remarks, extracted from an editorial article in the St. Louis Medical and Surgical Journal, to the attention of our readers, because they denote an elevated, manly, and philosophical spirit, which are better calculated to win favour for their school than the clap trap and sense. less appeals to sectional spirit and popular prejudice so loudly urged by some of the schools in order to attract students, and which have always seemed to us to indicate a sense of weakness and a feeling that bet ter claims were wanting:-]

"In urging the claims of St. Louis as a point for acquiring a medical education, and in directing the attention of western students to these claims, which we unhesitatingly do, we at the same time wish it distinctly un

They both gave a history of their practice in diseases of the eye, which is different from the defendant's practice, as testified to and shown by a card, which is admitted to be his. The defendant offered to prove byderstood that we are governed by no narrow a score of persons that they had had bad eyes, and been treated for them by the defendant and got well, or improved, which was ruled out by the Court. The defendant's counsel raised several points, but the second one is sufficient to state-" That an error in judgment is not malpractice."

or sectional feelings, but do so upon the broad grounds of equal facilities. We claim no superiority over other large cities, while at the same time we admit no inferiority. Thus influenced, we again repeat what we have heretofore said, that we can see no good reason why western students should The Court held that to be good law, when forsake their own home institutions, to crowd applied to a man skilled in anatomy, sur-eastern schools to such an extent as to render gery, or physics, but that it had no applica- it impossible-from the very numbers pretion in this case; that the defendant, know-sent-for them to derive any advantage ing nothing of anatomy, surgery, or physics, whatever from hospital instruction. We could have no judgment in the matter. The would not if we could, by word or deed, fan law contemplated a judgment founded upon the flame of sectional feeling, at present, skill and knowledge in these sciences. unfortunately, so rife in the land, neither would we circumscribe within narrow boundaries the great 'republic of medicine.' We love our profession-we love our country, and our whole country; but, if what we have said be sectionalism, then are we sectionalists."

That man who would hold himself out to the world as a doctor and an oculist without { a diploma, without any knowledge of these sciences, and under such false pretences obtain a patient, and commence tinkering with the most delicate of all the organs, the eye, must be reckless indeed. An error in judgment, of a man skilled in a particular calling, is not malpractice, unless it is a gross But error in judgment, in a science, of a man unskilled in that science (if such a thing can be) is malpractice. In other

error.

Yellow Fever near New York.-A number of cases of yellow fever have occurred at Quarantine, Staten Island, at Brooklyn, and at Fort Hamilton. There have been admitted to the Marine Hospital at Quaran

tine from Aug. 28th to Sept. 9th, 146 cases of yellow fever, and there have been 25 cases among the employés.

rious effect. In searching what could be the cause of the differences between their experiments and those of M. Goubaux, they I found that it was in the mode of experiNew York Medical Times.-This well- menting. M. Goubaux used to put a ligaconducted journal, which has ever supported ture round the esophagus, after having the honour and respectability of the profes-given the salt to his dogs, and MM. Bouley sion, and contributed its quota to the ad- and Reynal did not employ this means. In vancement of our science, terminated with examining what would be the effects prothe September number. We regret to partduced by the application of a ligature round with so able a contemporary, and one the oesophagus in healthy dogs, they found which has always claimed our respect. that frequently this operation caused death. Already, Giacomini, Devergie, and Rog.

College of Physicians and Surgeons, New netta, criticising Orfila, had said that the York. Dr. Samuel St. John, of the Cleve-ligature of the œsophagus was a serious land Medical College, has been appointed to the Chair of Chemistry vacated by the resignation of Dr. John Le Conte.

Physicians' Visiting List.-Messrs. Lindsay & Blakiston has published this highly useful little volume for the year 1857.

FOREIGN INTELLIGENCE.

operation, and that the great toxicologist had often attributed to poisons, symptoms produced by this operation. Orfila had answered with his customary violence; and he was so positive in his affirmations that the ligature of the œsophagus is an innocent operation, that the public had admitted his assertion. The experiments of MM. Bouley and Reynal seem to leave no room to doubt; they show that various symptoms, some of them very serious, are frequently the result of the mere tying of the esophagus. In their first paper they state that, out of eight dogs upon which they had performed this operation, five died in from two to seventytwo hours. Of the three dogs that survived the operation, one only recovered quickly after the removal of the ligature, which had

was ill four days, and the other eight days. In another series of experiments, in which a small quantity of common salt or of emetics had been injected into the stomach, before the application of the ligature round the oesophagus, the efforts of vomiting were very great, and death ensued very soon after in six dogs out of seven.

Effects of Ligature of Esophagus.-It is well known that a number of our notions about many poisons, rest, at least in part, upon experiments made by Orfila, in which this eminent toxicologist had tied the sophagus of dogs, to prevent vomiting, after having injected into the stomach the sub-been left two hours; of the two others, one stances suspected to be poisons. The results of the experiments of Orfila would have but little value, if it were proved that the ligature of the oesophagus alone could produce many of the effects he attributed to poisons, or rather to substances considered as poisons. According to MM. Bouley and Reynal, Professors at the Veterinary School at Alfort, this supposition seems to be the truth. Some time ago, M. Reynal discovered that brine is a violent poison in certain doses. One of his colleagues at Alfort, Professor Goubaux, published recently a paper, in which he says, that common salt is also a poison, and that the tonic powers of brine are mostly due to the common salta dose of this substance to a dog, the œsoit contains. M. Goubaux went so far as to say, that even a dose of 40 grammes (one ounce and a third) of common salt is sufficient to kill a dog. MM. Reynal and Bouley, on the contrary, have ascertained that even 100 grammes of salt may be given, at one meal, to a dog, without any delete

In a second paper, MM. Bouley and Reynal have tried to show how much Orfila was misled by his mode of operating. According to this eminent toxicologist, 3 grammes (2 scruples) of subnitrate of bismuth are sufficient to kill a dog. This seems to be true if, after having given such

phagus is tied; but, if it is left free, this dose has no bad influence whatever, as might be expected by practitioners, who give daily much larger doses of this substance, and by those who know that Prof. Trousseau often gives at once 30 grammes (1 ounce) of this medicine, and that M.