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of the lower jaw, obliquely through the mouth, over the baseof the tongue, which was wounded by it, and out on the otherside, behind the ascending ramus, midway between the angleand condyloid process. The wounds were healed, and the manwas able to open his mouth about a third of an inch. He saidthat he was cheering at the time as he was entering the fort,and he attributes the small amount of injury to his tongue tothe fact of his mouth being open. He states that he spit agood deal of blood, but he believes it came from the wound ofthe tongue. It is wounderful how the carotid escaped.

2. Another man was alive and well, having been shotthrough the left side of the chest. The ball entered just abovethe heart, and passed out apparently in the same line at theback. The ball must have gone with great force, as it piercedthrough his knapsack, blanket, &c. From the direction, youwould suppose that it must have divided some of the largevessels. The respiratory murmur was distinct, but rather loudunder the cicatrix. He said he was a little short-winded, butotherwise well. He looked in good health, as, indeed, did thewounded generally.

3. Another was shot through the abdomen; the ball frac-tured the lower part of the eighth and ninth ribs on the leftside, and passed out in the lumber region, wounding, it wassupposed, the kidney, as he passed some blood in the urine.He cannot stand upright, and suffers a good deal of pain onpressure in the left iliac and hypogastric regions, where therewas a considerable swelling when on his legs. He did notlook ill.

I saw several good stumps, the amputations being performedby Mr. Longmore, of the 15th Regiment, on the field ofAlma.

REPORT OF A CASE OF

SOFTENING OF THE CEREBELLUM,WITH

PARTIAL LOSS OF MUSCULAR POWER IN THE LOWER EXTREMITIES,AND MORBID STATE OF THE SEXUAL FUNCTION.

BY ROBERT BIANCHI, ESQ., M.R.C.S. & L.S.A.

W. R., aged sixty-five, was formerly a porter in the BoroughMarket. During his occupation, he used to drink to a greatextent, and was altogether irregular in his habits. Betweenfourteen and fifteen years ago, he became an inmate of St.Saviour’s Union Workhouse, having been compelled to leavehis employment, on account of a gradual loss of muscularpower in his lower extremities. Since his admission into theworkhouse, various remedies (amongst them strychnia andelectricity) have been tried, without the slightest benefit; andalthough he did not get worse, still there was no improvement.He has always been able to walk about by means of a stick,but if he attempted to hurry, directly fell down. When

spoken to quickly, his legs would start, and would remain ina state of agitation some minutes. About seven months ago,he began to have incontinence of urine, and since that periodhas almost entirely remained in the same ward. He went to I

bed, no alteration being noticed by the other inmates of the Iward in his state of health, and was found dead in the morning. IWhilst living in the workhouse, his extreme partiality to thefemale sex has been remarked, and also that he was constantlyaddicted to masturbation. (These facts I have ascertainedsince making the post-mortem examination; and also that hiswife had not lived with him for two years, while he was ableto get his own living, on account of his want of constancy.)

Post-,nio2,te,m Exa7nination, fourteen hours after death.-The body generally was rather emaciated, the scrotum andthighs excoriated, and the testicles extremely small; bothlower extremities much wasted. The cerebrum, after a verycareful examination, appeared quite healthy. On attemptingto remove the cerebellum, I found it impossible to do so, thewhole substance breaking down on touching it, althoughbefore attempting its removal the proper form was preserved,and the grey matter was still distinguishable from the white.The medulla oblongata was quite healthy. On examining thechest, I found a large abscess in the right lung, but could nottrace any bronchial tubes into it, which would account for itsnot presenting itself as a symptom during life. The left lungwas perfectly healthy. The heart was a good deal encumberedwith fat. The liver in a state of cirrhosis. The kidneysshowed granular degeneration. There was thickening of the ’,bladder generally, and a small abscess had formed by the sideof the rectum.

This case appears to me to present considerable interest in aphysiological point of view- whether the softening of thecerebellum was primary, and had led to impairment of themuscular power in the lower extremities, and a morbid con-dition of the sexual appetite, or that inordinate indulgence insexual intercourse (and perhaps at that period masturbation)had been the cause of disease in the cerebellum, followed bypartial loss of the power of progression. For my own part, Iam inclined to believe the affection of the cerebellum was

primary, and led both to the partial loss of muscular powerand a morbid state of sexual desire; and it appears to me,that this case tends to show that the cerebellum is connectedboth with the sexual function and co-ordination of muscularmovement and power; and that perhaps, as has been suggestedby Carpenter, the former is influenced by the central part, andthe latter by the lobes of the cerebellum.

Blachfriars-road, February, 1855.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

Nulla est alia pro certo noscendi via, nisi quam plurimas et morborumet dissectionum historias, tam aliorum proprias, collectas habere et interse comparare.—MORGAGNI. De Sed. et Caus. Morb. lib. 14. Proœmium.

GUY’S HOSPITAL.

POPLITEAL ANEURISM TREATED BY COMPRESSION, WITH FAILUREOF THAT METHOD, AND DELIGATION OF THE ARTERY IN THETHIGH.

(Under the care of Mr. COCK.)

MR. COCK placed a ligature on the femoral artery in a case atGuy’s Hospital on the 24th ult., in which a large poplitealaneurism appeared on the point of bursting, and in which themode of cure by compression had not succeeded as well as hehad anticipated. It was interesting and instructive to find, asfar as London is concerned, that such an operation now atGuy’s and several other hospitals is entirely exceptional, thegeneral impression of the surgeons of the larger hospitalsbeing quite in favour of the milder plan of treatment by com-pression. The man is still under treatment, and doing well;and though a few years ago such operations by the ligaturewere the rule, and presented little of novelty, the case is ofinterest as an exception rather to an opposite rule, the plan nowgenerally adopted.James C-, aged about forty, was admitted into Guy’s

Hospital on the 15th of January, with a large popliteal aneu-rism. He is a heavy, unhealthy-looking man, of very stolidappearance; and though he has had the compression apparatusput on with care, and explained to him, it is feared he will notattend sufficiently to it. There is nothing very peculiar aboutthe history of the case different from all such accidents; thesize of the swelling in the ham, however, appeared veryalarming; the pulsation also is very marked and throbbing.Mr. Cock placed him under the effects of digitalis, to restrainthe circulation, and had the compression apparatus carefullyapplied.

Jan. 23rd.-It is found that the parts under the pad havesloughed; and as there is very little diminution of the swellingor pulsation, and much fear that the artery may give way inthe ham, Mr. Cock advised the operation by deligation.

Cases of aneurism like the present, it need scarcely be said,are chiefly of interest in a practical point of view. The mode

by compression did not fail here, as observed by Mr. Cock,from any inherent defect in the principle so much as from apeculiar constitution of the man, joined to a heaviness of man-ner, which prevented him attending to the proper adjustment

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of the apparatus; so that the skin and cellular tissue over the lfemoral having become sloughy from a very short pressure, itwas not thought advisable, nor at all possible, to continue it;not that the slough at all extended to the artery, for wewatched this at Mr. Cock’s elbow during the operation, butthat this lesion (only skin deep) prevented further pressurebeing made in the proper situation. Offering a useful hint, todust the parts with flour, and to use alternate pressure aboveand below a given point alternately, as recommended by theDublin surgeons, it is not necessary either to stop the circtila-tion completely in the artery, but to diminish it.No little controversy has been excited of late years as to

what is the best plan of compression in aneurism-a screw, aweight, or a spring. By the almost unanimous consent, how-ever, of all our hospital surgeons, elastic pressure seems to bethat now generally adopted. In aneurism of any of the arteriesof the upper extremities, elastic pressure is more particularlyadvisable, while a weight of lead or shot may in many cases ofpopliteal aneurism be found available in controlling the circu-lation, more particularly at the groin, the screw apparatushaving been entirely discarded; the screw tourniquet or clampalways, amongst other disadvantages, gives rise to impatienceof pressure on the part of the patient-he feels as if " pinioned"down or nailed to his bed; while, on the other hand, theelastic spring, if properly placed on the limb, is rather agreeableto the patient than otherwise, and will be found quite sufficientfor restraining the current of the blood through the aneurismalsac. Indeed, in a case lately given, a patient continued thespring apparatus of Dr. Carte for seven hours without stopping,at the end of which period the pulsation in the tumour of theaneurism had ceased; the latter had become solid, and nothingelse was required to complete the cure, absorption going onrapidly; the screw clamp, on the contrary, in this case, couldnot be borne even for half an hour. Mr. Teale, of Leeds, latelygave a case cured by compression in twelve days. We haveattended with some interest to a case lately treated by Mr.Adams at the London Hospital, and others under Mr. Fer-gusson.The statistics of compression are now very satisfactory: of

23 cases of aneurism treated in this manner in London up tolast year, 14 had been cured, while in 9 it had partially failed.Very considerable judgment is necessary in selecting cases,and the most vigilant care is required to watch that the fewsimple directions necessary are properly carried out by thepatient; half the cure is in the patient himself. It should notbe forgotten, too, that compression, if it do not succeed, as inthis case of Mr. Cock’s, may do positive harm; if the instru-ment shift its place off the vessel, the treatment is less thannugatory, as it leads to engorgement of the limb, and diffu-sion of the contents of the sac of the aneurism. It is toooften said, perhaps, the " clamp" can do no harm; but this isnot the case. Besides these 23 cases, it is reported that 47cases have been treated in Dublin with similar results: 36were completely cured. These are all the cases from 1842 to1854, taken indiscrimi ately.Mr. Skey having suggested, in his college lectures, that the

success in Dublin was rather to be attributed " to the fortu-nate opportunities of repetition of the operation in that city,"that objection cannot any longer hold good, as we have hereall the cases, and it is found the proportion of successful onesis as great during the first years of its introduction as thelater. The spring tourniquet, or " clamp," is a manifest im-provement on the common screw tourniquet: surgeons have etried it in single, and often very unpromising cases, with goodeffect, even where the entire arterial system was diseased.Amongst the recent cases of cure, we find one of poplitealaneurism cured by pressure of the patient’s own thumb steadilyfor a week against the femoral; in another case, of doubleaneurism-the left had been previously ligatured, while theartery in the right limb was cured by compression, one opera-tion apparently as good as the other.

Feb. 25th.—The man has now been a month in the hospital.The case has gone on very favourably, almost identical withthat mentioned (p. 147) by Mr. Syme, whose observations onthe present subject have excited no ordinary interest in hos-pital classes. There can be little doubt, it is said, that deli-gation of arteries in hospitals would be a more satisfactoryand certain mode of cure in aneurism; but, as in one of thecases quoted by the Edinburgh Professor, we have phlebitisand other accidents to fear, the dangers from deligati’Jn being25 deaths in every 100 cases, from which the mode by compres-sion is comparatively free; while on the other hand, it is urged,that in cases of operation like this by Mr. Cock, where theoperation is carefully done, we have nothing to fear.

KING’S COLLEGE HOSPITAL.

GUN-SHOT WOUND OF THE SHOULDER-JOINT; PRIMARYAMPUTATION.

(Under the care of Mr. FERGUSSON.)j VARIETIES of gun-shot wound at present possess an interest of £more than ordinary character, as many of our younger sur-

geons and students are being called away to the hospitals atConstantinople, they cannot too much avail themselves of suchcases. We have just seen a very marked case of the kind,while incidentally visiting this hospital on Thursday, the 15thinst. (not the operation day). A poor young man was broughtin, who, taking advantage of the frosty weather, had been ona fowling excursion. In drawing his gun through a hedge, helodged its contents in his shoulder, shattering and breakingthe bone. Mr. Fergusson, after a careful examination of theparts, in conjunction with Mr. Bowman and his other col-leagues, advised immediate amputation. If such a mass ofshot and slugs had not lodged in the bone, and if the bone werenot splintered and shattered as we felt it to be with the finger,it might have been a question whether it could not have beensaved. If it had been a clean wound of a musket bullet inbattle, inasmuch as the axillary artery was uninjured, it mighthave been open to discussion whether it should not have beentreated as a bad comminuted fracture without operation. Theyoung man appeared in robust health, and did not suffer verymuch. Taking all the circumstances of the case, however,into account, and fortified in his view by a case of a somewhatsimilar kind, in which he had trusted too much to nature, Mr.Fergusson, at the entreaty of the patient’s friends, decided atonce on a primary amputation at the shoulder-joint. Theaccident had occurred the previous evening, so that the shockof the injury had in some measure subsided, and a more fullexamination of the parts was now necessary.

Opera<:OM.&mdash;Having been brought into the operating-theatreon Thursday, and placed carefully under chloroform, a veryfull examination of the parts was accordingly practicable-anadvantage in the use of chloroform in gun-shot wounds toomuch underrated. A large lacerated wound (not unlike thatin the case of Mr. Skey’s, which we gave at page 155 of thepresent volume) was found in the upper third of the right arm,at the side of the axilla, penetrating apparently towards thejoint; the bone was broken also into several splinters, andlodging a quantity of shot and unburnt gunpowder. The opera-tion was a little peculiar, as Mr. Fergusson used a forceps ofhis own construction, which seemed to act admirably, in seiz-ing and holding the shorter piece and head of the humerus afterthe hand and forearm and upper part were detached. In allsuch formidable operations of cutting out the shoulder, it isapparent that the surgeon must be in a measure guided by thenature and extent of the injury, and the parts possible to besaved for flaps, &c. Mr. Fergusson decided on the operationknown, we believe, as Lisfranc’s-namely, with two flaps.Mr. Fergusson did not use any pressure above the clavicle onthe artery, but Mr. Bowman undertook to watch it carefullywhen cut, and seize it as the knife was forming the second flap.Mr. Fergusson now, standing at the side, made one of his largerapid sweeps of the knife round the lower part of the deltoid,and another posteriorly. As it was necessary to have a full

’ examination of the splinters of bone, &c., the broken ends ofthe limb were at once separated, when the terrific state of theparts, a black mixture of gunpowder, shot, and broken bone,at once became evident. Catching the shorter piece of thehumerus in his forceps, after the artery was tied, it now seemedthe easiest plan to use disarticulation. Mr. Fergusson wisely

: preferred sawing the bone, to see if the joint could be saved;.

but the latter having been implicated in the injury, he was. obliged, even after sawing the bone, to resort to disarticulation.: The man, we regret to say, has since sunk from the shock of &pound;

the injury.

ST. MARY’S HOSPITAL.

RUPTURED PERIN&AElig;UM, WITH PLASTIC OPERATION; RECOVERY.

(Under the care of Mr. I. B. BROWN.)CASES of ruptured perinseum are very often met in practice,

oftener indeed than the village or country practitioner, perhaps,knows what to do with them. We do not speak now of courseof the fourchette simply torn after labour, but of the perinseumand sphincter both completely ruptured, attended with dis-placement of the pelvic viscera, inability to control the actionof the bowels, and other distressing symptoms. The difficulties

1 to be overcome in the treatment of such cases, have, we need