which state he did not rally until the 2d day. Opium and wine were ordered.

4th. Skin hot, and diarrhoea Mist. effervesc, c. T. opii, gtt. v. 4tis horis. Porter, ss.

5th. Very little alteration. Porter, j. Eggs, ij. Cal. gr. j, Op. gr. ss. n. s. Mist.

efferv.

6, F. M. Omit the porter. Vini rub. 3 vj.; Mist. cretæ post sing. sed. liq.; T. opii, gutt. xx. statim.

9th. Wound was dressed; and, but for some small sloughs, was looking pretty healthy-he was not materially altered in other respects.

10th. Last evening his stump became painful-he complained of nausea and occasional retching-he is to-day in a very low state-his countenance is cadaverous, and pulse rapid and feeble-he answers with reluctance, and notices nothing. The parts surrounding the wound are swelled, and the dressings are in part removed-brandy was ordered hourly. No change but that of evident sinking took place after this report. He died this evening.

The amputated limb exhibited, on examination, not an aneurism from wound of the artery, but a wound simply of the accompanying vein. With respect to the other part of the limb nothing particular was found-thickening of the integuments round the wound for some distanceoedema of the lower arm, and superficial gangrene.

picis liquid, 3 ss.; Pulv. glycirrhizæ, q. s. ad massam formand. quam in pil. xl. divide cap. iij 6tis horis; Balneum tepid altern. auroris.

This remedy was continued for about five weeks, when he complained of sickness to a great degree, so that it could no longer be borne on the stomach for any length of time, and the impure prussic acid was prescribed. The effects of this equally nauseating medicine I have not been able to collect, nor do I know the object of its application. 'Tis true, that the scales are now pretty generally cleared from the skin, but it must be supposed that the bath was more influential in removing them than the pitch; and of course, as far as the constitutional disposition is concerned, little amendment can yet be visible. Dr. Mason Good alludes to this treatment, but says, that he never heard of any permanet good effect from it; for, as soon as local remedies even are withdrawn, the scales have re-appeared.

The pathology of this disease seems to be a metastasis of the secretion of the calcareous earths. In like manner, Dr. Good relates two cases, where calcareous matter was secreted with the saliva and urine, and where, upon examination of their bones after death, little more than cartilage was found, of which “the scalpel, with very little force, ran through the hardest." But a simple vitiated secretion is seen in mollities and fragilitas ossium, of which the present case can be but a variety.

XV.

ICTHYOSIS.

XVI.

LAR MEMBRANE AFTER BLEEDING.

His bowels are confined, so that a week will sometimes pass without his procuring a stool; he has thirst at present, and a bad appetite; his urine is in full quantity, light in colour, and without sediment his body is constantly itching. Ordered

SARAH GROOMBRIDGE, a plethoric girl, of 21 years, was admitted, 23d of July, under Mr. Tyrrell. She complains of pain and heat extending above and below the elbow-joint to a considerable distancethere is much swelling, so that the arm is nearly twice its natural size, affording a pit on pressure, and producing some pain by the motion of the fingers. Two days after being bled, she states that her arm began to be painful, and to swell. Poultices and opening medicine were employed, and it gradually increased to the present

state, being four days from its commencement. There is some constitutional excitement, the skin is dry, pulse full, and tongue white; there is thirst, and her bowels are constipated, unless moved by medicine. Ordered, Hirud. xxx.; Lot. plumbi subacet. dilut. c. cataplasm miscæ, panis. Hydr. submur. gr. v. hac nocte sumend.; M. s. c. cras mane sumend. et rep. ad sedes liquid

24th. Excitement increased, and local symptoms more severe. Hirud. xx. cat. lini.

portion of the tibia, and a small piece of the upper portion lay detached within the wound; there was no difficulty in reducing it, and but little blood issued from the wound; a small dossil of lint was laid upon the orifice, and the leg was placed between two splints, laid upon the back, and raised at the heel. In the evening some swelling was perceived, and the patient complained of great uneasiness—— the splints were loosened, and a spirit lotion to the whole leg; after which, nothing untoward occurred until the even

27th. Pain and redness of the arm are gone, but have left considerable swelling, which pits on pressure. Some watery fluid, resembling pus in colour, has escaped from the puncture of the venesection. All fever, is gone.

30th. A second puncture was made, and a large quantity of thin watery discharge was evacuated. Some hardness

left.

2d August. Emp. saponis to be applied up the fore-arm.

This case although it may not have been so severe as is often presented to us, will serve to illustrate the usual practice at this hospital of treating similar cases, Mr. Tyrrell has a great objection to the decided measures proposed by Messrs. Earle and Hutchison, vis. of incisions; for, in his opinion, the only real benefit is the loss of blood; but, then, we have no command over the quantity, and patients have repeatedly been known to sink from that cause; while, by leeches, the same object is arrived at, with comparative certainty, and its success has been fully established. With Mr. T. this plan has never failed, where he has had the commencement of the attack to deal with.

ing the wound appeared much inflamedpulse raised, skin hot, and thirst-his bowels were confined. Ordered s. C. cochl. iij. 2dis horis donec alvus respond.

2d. A small sloughy spot covers the wound, and an inflammatory blush extends over the whole leg-pulse is full, but very compressible-tongue brown, skin hot— 18 leeches were ordered; a poultice over the wound; the spirit lotion to be continued; and the splints to be entirely removed. Rep. m. s. c.

3d. Sloughing has continued. P.

4th. The lower portion of the tibia is exposed-slough increased. The leg was to-day placed in Sir A. Cooper's fracture box, which operation produced no pain.

5th. Some healthy discharge-fever gone--pulse much lessened in volume, and quicker. Porter #j. quotidie.

7th. Limb looking better-inflammation subsiding, but his bowels are very relaxed, and he is scarcely able to retain his stools. Mist. cretæ c. to be taken after every liquid stool. Port wine, 3ij. and porter.

9th. Debility increased-bowels still purged-tongue brown-pulse quick, and very compressible. Omit the porter, in the fear that it gave rise to the diarrhoea. Wine, 3iv. R. T. opii gtts. x.; Ammon. carb. gr. v.; Mist. camph. 3 iss. 6tis horis. s. sago and syrup.-Continue the poultice.

12th. Restless-pulse irregular-vital powers evidently sinking. Brandy ad libitum.

From this report he gradually sunk. His age and constitution were both points of great consideration. The same degree of inflammation in a young and robust subject might have been combated with blood-letting, but certainly could not have been treated without its employment.

The pulse here was of that full, but powerless volume, which indicated a flabbiness rather than excess of action in the heart and arteries, and, as such, the small abstraction of a few ounces of blood would have been attended, perhaps, with a fatal syncope. The case might be contrasted with a similar injury, in a middle-aged man, where a great destruction of parts was attended with very little suffering of the constitution.

JOHN ELLIS, æt. 22, was admitted, after having received a blow upon the upperarm from the handle of a winch, while nearly a ton weight was hanging to it. On examination, a fracture was found, extending obliquely downwards and outwards, through the shaft of the humerus, at its lower third-a small wound communicates with the lower portion-there is not much tumefaction. The wound was dressed with adhesive plaster, and the limb supported by two splints, one on the inner and the other on the outer side. A cold lotion was ordered, and the forearm kept at right angles with the upper, raised on a pillow.

A few days after, he complained of uneasiness, for which the splints were loosened; but, the wound being on the under side, was not examined, from time to time, so regularly as would have been permitted, had it been situated elsewhere. On the 7th day, great pain was experienced, and febrile symptoms developed themselves; this was considered to arise from the riding of bones, since the splints could give no support, from their looseness. The patient was, therefore, directed to sit up, when the wound, which was in a foul condition, was discovered to be surrounded with a large slough; it was, therefore, dressed with the red precipitate ointment, and supported by four well padded splints, lightly applied. He was desired to remain in the semi-erect position, and suspend the elbow, while he supported the fore-arm only, at right angles with the upper, in a sling. This gave him great ease; and, from this time, the splints were gradually drawn tighter, as the inflammation subsided, and the sore would bear pressure. His health suffered but little, and all excitement subsided so soon as the irritation was withdrawn.

It must be desirable, in compound fractures, that rest, and the recumbent posture should be enjoined until all inflamVOL. VIII. No. 15.

matory symptoms shall have subsided, even in the upper extremity, where motion need not be used: and the present case is an exception, only because the wound being on the under side, the limb was necessarily disturbed at each dressing; and, from the riding of the ends of the bone, in consequence of its obliquity, the inflammation must, thereby, be kept up, if not altogether excited. But the extension which the weight of the elbow afforded, got rid of the real source of irritation, and allowed of sufficient pressure to support the limb, and effect a comfortable apposition of the broken ends. Nothing afterwards retarded his gradual recovery.

XVIII.

A CASE OF POISONING BY ARSENIC.

A woman, apparently about 60 years of age, was brought into the hospital, under Dr. Elliotson, in a state of exhaustion; her pulse was scarcely perceptible, skin cold, and pupils fixed-she was incapable of answering when spoken to-pressure in the epigastric region gave excessive pain, under which she would writhe and exclaim some imperfect sound; her breathing was not at all affected; her tongue was dry,and she appeared to wish for drink constantly.

Those who brought her, knew little or nothing about her, but informed us that, on entering a neighbour's kitchen, about an hour ago, she had begun to eat some bread-crumbs, which were lying in a plate mixed with arsenic, for the purpose of destroying black beetles, but would not desist on being warned of it.

The stomach-pump had been used, sufficiently merely to obtain a specimen of the contents of the stomach, which, together with the remaining crumbs of bread, were analyzed by Dr. Bruton, and found to contain arsenic. Another pump was procured from the hospital, the former being out of repair, and a second attempt was made by the dresser, when the stomach was emptied and filled several times with luke-warm water, until the fluid came unchanged by any admixture from the stomach; it having received a tinge of blood each time. Nearly two hours had now elapsed since the accident. The treatment became then a matter of consideration. Inflammation existed, as was clear from the excessive pain about the region of the stomach, no less than from the blood which stained the water. The 35

state of exhaustion, however, forbade blood-letting; but a large dose of opium was determined on, and mucilaginous fluids; a glyster of ol. ricini and ol. olive was given; leeches, also, were ordered, but she sank before they could be applied.

XIX.

A CASE OF SUPPOSED FUNGUS OF THE BRAIN BENEFITED BY IODINE.

WILLIAM HICKS, æt. 44, admitted, under Dr. Scott, 12th July, 1827, complains of imperfect vision of the left, and total darkness of the right eye. The recti muscles are likewise partially paralysed, their motion being very limited, if not altogether gone: thus he is able only to turn the right eye upwards, and the left a little to the side in addition; no adaptation, therefore, of the eyes can take place, and he sees objects doubled beyond a certain focus, the axis of the one crossing that of the other, at a certain point. The pupils are small, and do not contract to the stimulus of light. He has, also, a numbness of the lower extremities, with occasional flashes of pain, extending from the foot to the thigh; there is such debility of these limbs, that he drags them after him in walking, and often misses his step. His hands, likewise, partake of

this debility, for they are not capable of offering any degree of force.

He has passed a sedentary life, being a weaver, and has been constantly the subject of head-ache for these two years past; bleeding, however, generally relieved it.

Dr. Elliotson, in the absence of Dr. Scott, said, he considered these symptoms to arise from the presence of fungoid growths in the cranium; he, therefore, ordered T. iodinæ, m. x. ter die; Abrad. capilli et app. ung, iodinæ, capiti bis die.

The patient continued these medicines, gradually increasing the former to xxv.m, until the 5th of August, when the stomach became irritable, and it was withdrawn. Its use had been attended with decided benefit: the eyes are less dark, and he can move them in almost any direction; his feet are stronger, less numbed, and but seldom affected with those stinging pains complained of on his admission. Blisters were made use of afterwards, but almost immediately upon the abstraction of the iodine, his pains returned, his walking was attended with the same uncertainty as at first, his sight became dimmed, and he complained of head-ache. The subsequent treatment I was unable to learn. G. WICKHAM, Winchester.

REASONS, which are sufficiently set forth in the address at the close of this Number, induce us to state that, in future, this Journal will be entirely dedicated to the subject of REVIEWS of Books and JOURNALS.- -Our HOSPITAL-REPORT PRIZE has called forth a number of competitors beyond our most sanguine expectations; and we have, at this moment, reports enough in our hands to fill a large volume. To several of the competitors we shall adjudge the prize, (as will be seen in the list,) although we are unable to give insertion to the Reports themselves. We claim the privilege, however, of handing them over for publication to some of our cotemporaries. To these cotemporaries, we have recommended the example of offering prizes for Hospital Reports; and we have reason to believe, that they will adopt it. We return our sincere thanks to the candidates who have favoured us with their labours; and we earnestly en

treat all who have opportunities of observing the events of HOSPITAL PRACTICE, to favour us with the correction of erroneous Hospital Reports, wherever they may be published, in order that truth may predominate over error. The HALF-MONTHLY Fasciculi, in which form this Journal will henceforth be published, will afford an immediate antidote to the poison of false reports; and, if surgeons do not embrace this medium of correcting falsehoods, they deserve all the evil consequences that may attach to the propagation of error. The statements must be authenticated to us: -but the contradictions must invariably appear in our own language. No original papers, of any description, can come within the three sheets of which each Fasciculus of the Journal will be composed. EXTRA-LIMITES must be at the expense of the individual claiming that medium.

1. Manual of Pathology; containing the Symptoms, Diagnosis, and Morbid Characters of Diseases; together with an Exposition of the different Methods of Examination, applicable to Affections of the Head, Chest, and Abdomen. By L. MARTINET, D. M. P. Translated, with Notes and Additions, by JONES QUAIN, A. B. Demonstrator of Anatomy at the Medical School, Aldersgate Street. Second Edition, revised, with additional Notes. 18mo, pp. 297. London, Simpkin and Marshal, 1827.

We are glad to see that the favourable opinion which we expressed of this Work has been confirmed by the rapid sale of the first edition. This second edition is considerably improved, and is still more entitled to public patronage.

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3. An Introduction to the Comparative Anatomy of Animals; compiled with constant Reference to Physiology, and elucidated by Twenty Copper-plates. By C. G. CARUS, Med. et Phil. Doct. Professor of Midwifery to the Medico-Chirurgical Academy at Dresden, &c. Translated from the German, by R. T. GORE, M. R. C. S. In Two Volumes, 8vo, pp. 371-400, with one Vol. of Plates, in 4to, pp. 50. Longman, London, 1827.

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gold. The diagrams and plans are so numerous and well managed, as to render the study of comparative anatomy throughout the whole range of animated nature, a matter of complete facility. It is a great acquisition to the zoological science and literature of this country.`

4. A Manual of Comparative Anatomy; translated from the German of J. F. BLU

MENBACH, with additional Notes by WILLIAM LAWRENCE, Esq. F. R. S. Surgeon to St. Bartholomew's Hospital, &c. &c. Second Edition, revised and augmented, by WILLIAM COULSON, Demonstrator of Anatomy at the Medical School, Aldersgate st. &c. &c. 8vo, pp. 379, 8 Plates. Simpkin and Marshall, London, 1827.

IF This Work is on a far smaller scale than the preceding, and not near so well adapted for the study of comparative anatomy. It will be much relished by those who have made advances in that useful and highly ornamental science.

5. L'Agent immediat du Mouvement Vital devoilé dans sa Nature et dans son Mode d'Action, chez les Vegetaux, et chez les Animaux. Par M.H.DUTROCHET, &c. &c. 8vo, pp. 226. Bailliere, BedfordStreet, Bedford-Square, 1827.

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8. A Treatise on those Diseases which are either directly or indirectly connected with Indigestion: comprising a Commentary on the principal Ailments of Children. By DAVID UWINS, M. D. &c. 8vo. pp. 274. Underwoods, London, 1827,

9. The Lectures of Sir Astley Cooper, Bart. F. R. S. Surgeon to the King, &c. on the Principles and Practice of Surgery;