manently cured; especially when we consider that patients return with a repetition of their symptoms, until mercury has been properly exhibited-of which the following cases are not uncommon examples. MARY WILSON, æt.-, was admitted under Mr. Green, 12th July, with a foul ulcer, involving the tonsil, arch of the fauces, and uvula. Her history is, that nine months ago she had a sore upon the labium, of a suspicious origin, which healed without the use of mercury, but that, shortly afterwards, a sore throat appeared, for which she gained admission into this hospital, took mercury, and went out cured; but it has again made its appearance, Now, upon speaking to Mr. Green, we learn, that the sore throat became speedily well under mercury, and that she left the hospital without that remedy being carried to its proper length. On this account the same plan has been adopted again; but the sore throat has again got well, and she, in like manner, has again left the hospital. Now although, such ingratitude and irregular conduct should prohibit any farther benefit from being held out to her, yet Mr. G. to establish his opinion, which may be useful to many others, has desired, upon her return, which he deems almost certain, that she may be re-admitted. JAMES GODFREY, æt. 26, was admitted 31st May, 1827, under Mr. Green, with several crusted eruptions upon his body, which are dark, elevated, and for the most part, circular. On the head there is a deep ulcer, exposing the pericranium. its edges are rounded and callous-Its surface flat and pale. This, he tells us, first shewed itself in a crust, which scaled off, and left a sore-it became gradually deeper, until it arrived at the present state. Nine months ago he states, he had a chancre, for which he took mercury, but to what extent is by no means clear certainly not sufficiently long. The sore healed, and shortly afterwards he was attacked with sore throat and blotches, for which he gained admission at this hospital; and, being in a bad state of health, was treated with sarsaparilla and Plummer's pill. He was presented well, but 66 V. EXTIRPATION OF AN INCIPIENT FUNGOID TUMOUR." WILLIAM STANSOM, æt. 61, was admitted, under Mr. Green, 23d June, 1827, with a large oval swelling above the pubes; its size is that of a large melon; it is moveable, hardish, ulcerated on its surface, and tuberculated-pressure produces pain down to the testicles, and up to the loins any strain, as also coughing, gives uneasiness in the part. He remembers it with the earliest period of his life, and was taught to believe it to be congenital. It was no larger than a pigeon's egg, and remained so until a year and a half ago; when, from no known cause, (his health being good,) it increased with some degree of pain. Nothing was done for it until ten months ago, when its growth was very rapid, and its surface began to ulcerate-it constantly bleeds, but to no great extent; a sort of water mixed with blood, as he terms it, issues from it. His health is good, and he complains of nothing; but is willing to have it removed. On the 29th he was conveyed into the operating theatre, and Mr. Green, after examining the tumour, determined on leaving a granulating surface, since the integuments were in part ulcerated. He began, therefore, with a circular incision round the base of the tumour, and, in dissecting it out, found it to be perfectly anterior to the muscles, but very deep, from the obesity of the patient. The A fear, however, seems now pretty generally excited against the harbouring of incipient disease-thus, I have seen a similar state removed from the side, before the constitution has become impaired, in Winchester Hospital, by Mr. H. Lyford; so, again, Mr. W J. Wickham, his colleague, removed a conical crust from the lip of a girl, under the apprehension that such might prove the source of future disease. Cancers, however, are even attributed to some such irritation. lignant disease, in general, may date its origin in the same way. VI. FUNGOID HIP. A ma looseness of the integuments allowed of the operation must now have been deemed their being approximated, and the edges out of the question-so rapidly had these were retained together by two sutures- changes manifested themselves. adhesive straps being applied afterwards. Nothing particular presented itself during the operation. The patient was carried to bed, and on the 5th day the wound was dressed, nothing untoward occurring in the interval. The edges of the wound had adhered for some distance on each side; but there appeared some little redness about the sutures, which were consequently withdrawn. Nothing interrupted the gradual formation of firm and healthy granulations, and he left the hospital on the 23d August, with a very small wound. This illustrates, if any single case can, the importance of removing extraordinary growths, even though they shall not have attained a formidable character; for, here, though indolent at first, it began suddenly and rapidly to assume malignancy. True fungus hematodes is usually met with in persons, where a general disorder of the system is indicated by a peculiar unhealthy aspect-a relaxed fibre-a sallowness of the skin, which is often covered with clammy sweats-a constant troublesome cough, and general debility. But it is clear that the present case was not precisely of that character, although the fungoid and tuberculated appearances indicated a state, which could no longer exist with impunity. The robust constitution, the general good health, and especially the absence of symptoms in other parts of the body, by which a similar disease might be feared, go rather to disprove a predisposition to fungoid disease; and, if so, they go likewise to determine the nature of the present state, viz. a local disease, produced by long and continued local irritation. It is this tumour which requires extirpation; or, delay may occasion a degeneration of it into someting very formidable. A case of glandular swelling of the neck, which occurred in the hospital, (I regret to say, too far back to allow of more than an allusion to it amongst these reports,) illustrates this; for there, delay was occasioned to the operation by endeavours to remove it by the local application of iodine. The constitution became gradually but irremediably affected, while the tumour, in a few weeks, assumed an enormous size, with all, or nearly all, the characters of the present case; and, had the health permitted even, THEOPHILUS WEDGE, æt. 44, was admitted under Dr. Elliotson, 31st May, with excessive pain in the left hip, shooting down to the knee-there is an increased rotundity of the buttock-walking, or any motion by which the glutei are put upon the stretch, gives excessive pain-he has been uneasy in the part for eight months, but the hip-joint has begun to swell about six weeks only. An antiphlogistic treatment was adopted, under the supposition that some deep-seated inflammation existed, until an elastic sensation was communicated to the finger on pressure, and there was a tuberculated appearance about the crista ilii, while the rotundity of the joint was immensely increased. Mr. Green was requested to see him, the 18th July, who agreed as to the nature of the disease he passed a lancet into one of these elastic tubercles, (convinced of its nature previously,) when a little watery fluid, tinged with blood, escaped, but not sufficient to diminish its prominence or elasticity. The case has now become more striking and of deeper interest than the former symptoms had led to; for, with the increased rotundity of the glutæi muscles, the bent position of the thigh upon the abdomen, is the easiest; and, indeed, extension now gives very great pain. This is inexplicable; but, upon reference to a case exactly similar, the postmortem examination of which evinced a most beautiful specimen of fungous ex ostosis, growing from both sides of the ilium, that from the venter projected considerably into the pelvis, and, no doubt, must so have displaced its contents, as to require all the room that the relaxed muscles could afford; for here, too, the thigh was bent upon the abdomen, and at last so rigidly, that no force could displace it after death, although the joint was not diseased. The appearance of the patient, though of a robust make, is altogether unhealthy-he has a pallid face, with a yellow conjunctiva-his cheeks are thin, and his countenance anxious; he complains of weakness, want of appetite, disturbed rest, and costive bowels; the remnants of issues are upon the buttocks; in consequence of which, a poultice has been deemed the best application. Pulv. opii, gr. j. o. n.―ol. ricini,p. r. n. August 15th. The tubercle, which was opened, has thrown up some large fungous granulations, which have bled freely at different times; the sores from the issues are but little inclined to heal; he has derived rest from the opium. CATHERINE HAYES, æt. 32, was admitted, under Mr. Green, 17th July, after having pushed her hand through a pane of glass in a drunken fit, and cut her arm about three inches above the wrist. She was in a state of syncope, as was said, from loss of blood. No pulsation was felt at the radial artery below the wound, and its division was, therefore, suspected. A tourniquet was placed upon the brachial, and she was conveyed to bed. The wound was cleaned with warm water, and as soon as re-action had come on, the tourniquet was loosened, and the artery found to be divided; the dresser then secured it above and below, and brought the edges together by adhesive straps. On the 8th day, both ligatures came away, up to which time, no untoward symptoms manifested themselves; some slight febrile attack existing for a few days only, in consequence of surcharged mamma, which a child of eight months had been sucking at, but had discontinued to do so since her admission. Some opening medicine was given her, and her breasts were drawn, under which she got quite well. From this time, the wound gradually healed, and the hand recovered its use and sensation. VII. DISLOCATION OF THE RADIUS FORWARDS. B. A. about 40 years of age, presented himself at the hospital 3d June, with, as he termed it, a stiffened arm. On taking off his coat and shirt, it needed scarce a moment's inspection, even for many who had never seen a similar case, to be well satisfied of the nature of the accident; so well marked were the symptoms of the head of the radius being thrown into the cavity above the internal condyle, and resting upon the coronoid process of the ulna. The fore-arm was bent at right angles with the upper, and the hand mid-way between pronation and supination. There is a marked depression anterior to the external condyle, where the head of the radius should be, and a prominent rise upon the ulna. On endeavouring to flex the arm, the radius is distinctly felt to strike against the humerus; I say felt, because a dislocation of the radius and ulna backwards will give the same sensation by the condyles of the humerus striking against the bones of the fore-arm, and can be mistaken, for I have seen it so, provided the thumb be not placed upon the head of the bone during the flexion. The rotation of the radius, is very limited, and the position of the hand is fixed. Mr. Green desired his dresser to grasp firmly the upper-arm from behind, just above the condyles, while he made extension at the wrist, with slight rotation outwards, so as to supinate the hand; in about 4 minutes, the radius appeared to yield, and was felt to have regained its proper situation. Equally powerful, and more continued extension had been made by the hand, so as to depress and act alone upon the radius; but ineffectually. The man refused to come into the hospital, and to submit to have his arm confined; but said it was an accident he was accustomed to, and had never been confined for its cure. He left us, and never re-appeared. A lad, by name JESSE JESSIAH, was admitted, under Mr. Travers, with an injury to his left elbow, and stated, that three weeks ago, he dislocated his arm; that a medical man saw him, and told him the nature of his accident; and, after making some forcible extension, charged him a guinea for its reduction; splints have been upon it ever since. Upon examination, there is found to be great swelling; the fore-arm bent at a very obtuse angle; and neither rotation nor flexion can be effected to any useful extent. By observing the axis of the humerus, the condyles are evidently thrown anterior to their proper place; while from that of the fore-arm, the head of the ulna certainly, if not of the radius also, is thrown backwards. On endeavouring to flex the arm, the condyles of the humerus clearly strike against the fore-arm; there is a depression behind and above the olecranon. Messrs. Travers and Green made their examination, and agreed that there was too much obscurity from swelling precisely to determine the nature of the injury; it was clear that reduction was impossible at this state, which was hourly going on to rivet the bones to their new situations. Mr. Green thought there was a fracture of the coronoid process; so that the original appearance of displacement would return on withdrawing the extension; and thus the present state will be no extraordinary circumstance, even though a supposed reduction should have been effected. Leeches were applied, and poultices, until all inflammation had subsided, and afterwards passive motion, for the purpose of making as useful a joint as the present circumstances would permit. Two dislocations of the head of the os humeri into the axilla came into the hospital on the 2d August, within an hour of one another. They were both wellmarked, the head being felt in the axilla, the lbow thrown out from the side, and the deltoid muscle being flattened. Both were easily reduced in the ordinary way; one remained in the hospital for a week, but the other refused to come in at all. VIII. A PROTRUSION OF THE FUNDUS OF THE BLADDER WITH THE UTERUS, EXTER NAL TO THE VAGINAL ORIFICE. CHARLOTTE HAWKINS, æt. 56, has been in the hospital several months, under Dr. Scott, but has lately complained of incontinence of urine,with very great pain in the region of the bladder. She states that, in her last confinement, she was torn, and a prolapsus uteri has inconvenienced her ever since. On examination, a laceration of the perineum extends nearly to the sphincter ani-the uterus is prolapsed, its mouth and neck being external to the labia-the fundus of the bladder seems pushed down in front, and, on endeavouring to pass the finger between them, is found connected firmly with it, so that the former never descends without the other. The repeated attempts to pare the edges of a lacerated perineum, without success, almost prohibited even its suggestion in this case. Dr. Locock thought a pessora of oak-barks bruised and enclosed in a muslin bag, would, perhaps, answer the purpose of supporting the part, and giving strength by its astringency. Very great difficulty was experienced in passing it, the vaginal membrane being much irritated, and a perfect state of misery was occasioned by its presence when introduced; for the discharge getting amongst the bark, softening it, and gaining from it a dirty colour, and an offensive smell, all contributed to excite disgust, no less than a great inconvenience to the patient. Pessories of different shapes had been tried, and all had been attended with some disadvantage. A cylindrical pessory at last was proposed by Mr. Green: it is an oblong and hollow piece of wood, with a stem attached to it, at the end of which is a ball and socket joint, to which tapes are fixed, to prevent its descent, in whatever position the body may be. This was found, after the stem was removed, to answer every purpose; not producing, as both the round or flat ones did, unequal pressure, and consequently pain and inflammation; but being adapted to the vagina, threw the weight of the parts sustained upon a larger surface. An injection is constantly used, in order to check the discharge, no less than to correct the foul state induced by its accumulation. SUSANNAH COOMBS, æt. 44, was admitted, under Mr. Green, 21st June, and, while in the hospital, directed our attention to a fluctuating tumour, a little larger than a walnut, on the left side of the neck. A small black spot was seen about its centre, of the size of a large pin's head-the end of a probe can be passed into it, after which a small quantity of watery fluid issues from it by pressure. There are two ulcerated spots on her shoulder, which, she informs us, were preceded by a similar tumour, which inflamed, mortified, and left the present state of parts. Her health is considerably disordered, as the sores would indicate, and the chief attention is directed to that circumstance. My object in relating this case is, that it is an instance of an encysted tumour arising from a sebaceous follicle, with the circumstances which suggested the idea self-evident; for the opening on its top, which is not the product of ulceration, can communicate with the cyst in no other manner than by the neck of that follicle whose bulbous extremity is expanded to form the cyst. Some time afterwards, the tumour became inflamed, and Mr. Green, on the 12th July, said that, contrary to surgical principles, he would make an opening, for he felt convinced that a process of sloughing would take place which would be extremely painful and tedious, and the incision, at the farthest, could but hasten it. After the introduction of the lancet, such an inspissated state of the contents existed, that it was necessary to evacuate it with a probe, when the nature of the tumour could be determined by the smell alone, vis. the most offensive of any secretion in the body. The part ulcerated, and she gradually got well. IX. A FATAL CASE OF WOUNDED LARYNX. THOS. WYAT, æt. 36, was admitted under Mr. Green, on the evening of 14th July, with a cut throat. He appeared in a state of exhaustion, or rather of suffocation, breathing with great difficulty, and having a weak, irregular pulse, cold skin, livid lip, and glassy eye. The dresser removed the dressings from the wound, which, notwithstanding the larynx was completely divided, was entirely closed. This gave exit to a large quantity of mucus, and was followed by a speedy relief to all the above symptoms: the wound was extremely irregular. Those who brought him assured us that a very large quantity of blood was lost; yet no vessel appeared wounded. Mr. Green was sent for, and, on his arrival, desired the wound might remain open, and the dresser to stay with him the whole night, VOL. VIII. No. 15. when, if unfavourable symptoms were developed, he was to be sent for again. Mucus continued to rush from the wound, obstructing the ingress of air, until 4 o'clock, when the man breathed without difficulty and slept. On the noon of the following day, some degree of febrile action was excited, and he complained of pain in the chest, which was covered for some distance with an erysipelatous blush-he is distressed by occasional fits of coughing. An injection of jelly, strong beef-tea, and 40 drops of laudanum, was ordered. 17th. Nothing has interrupted the symptoms of the last report, either for the better or worse. Being incapable of utterance, he has expressed himself in writing to have been desperate in the attempt at suicide, but that it was his intention to submit to any restraint placed upon him for his benefit. Mr. Green fed him with the stomach syringe, and desired it to be repeated twice a day. The food was the same as the injection. 20th. Mr. Green ordered a third meal a day, of biscuit powder, milk, and brandy, finding a decided sinking of the pulse indeed, he expressed himself astonished that no alteration had taken place before. The wound gapes at least an inch and a half, and rather than being inclined to heal, appears rounded off at the edges and foul, as if partly by an ulcerative, and partly by a putrefactive process-the pain and tightness of chest are gone, but he gets no rest. From this time his strength gradually sank, without any alteration of symptoms, until the 21st, when he died. cartilages were found to be jagged and On examining the wound, the arytenoid divided; the thyroid separated both from them and the trachea; there appeared no from a fit of coughing during the attempt wound in the œsophagus, as was supposed to feed him without the syringe. No artery or vein was wounded. X. SPASMODIC CONTRACTION OF THE SARAH FOTZER. æt. 17, appeared at the surgery with a contracted thumb. She stated that, an hour previously, she had struck her thumb suddenly with a patten, which was followed by immediate pain 34 |