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rheumatism, four years ago. (Signed) BURYS. DASHNT."

" Jan. 16,1837. After five applications hewas able to come from Greenwich alone,and after six more could see to pick up aglove thrown upon the floor. Has had no-thing done since the 6th Jan., from illness.

(Signed) F. H. BAILLIE."In the above remarks I have stated, not

only in justice to Dr. Turnbull, but in jus-tice to the efficient plan of treatment whichhe has struck out, the simple facts of thecase. Presuming that Mr. Dasent’s anxie-ties to advance the profession and benefithumanity are as intense as my own, 1 mustnevertheless infer that lie is singularly defi-cient in powers of memory. But 11 literascripta manet." This is my only argument,and it is an effective one. I am, Sir, yourobedient servant,

.

J. LYON, M.R.C.S., London.25, Montague-street, Russell-square.

May 15,1837.

*.,;* Having published the charges of Mr.Dasent, and the foregoing statement in re-ply, we beg to observe, that we shall nothave room in our pages for a single addi-tional line which may not prove to be essen-tial to the elucidation of the truth respectingthe points under controversy.-ED. L.

J. LYON, M.R.C.S., London,

AMPUTATION AT THE KNEE-JOINT

EXPERIMENTAL MURDERS.

THOS. A. BURGESS, M.R.C.S.

To the Editot- of THE LANCET.SiR:—I beg leave to communicate to you

a few particulars relative to an operationwhich has long since been condemned byBritish surgeons as bad and impracticable,but which has been revived during the lastsession at the Hopital la Charité, of Paris,by M. Velpeau. I am, Sir, your obedientservant,

Tnos. A. BURGEss, M.R.C.S.11, Caroline-street, Bedford-square,

Mary, 1837.

The operation of amputating at the knee-joint has been revived by M. Velpeau, thedaring surgeon of the Hopitalla C/Mt’e,and performed three several times duringthe past winter, in cases of caries of thehead of the tibia, the object of the operationbeing merely that of leaving the patient ahette· stump. The operation had been per-formed three times in the space of three orfour months, in each of which cases it provedfatal about the seventh or ninth day fromthe time of the operation. In the last casethere seemed to be no actual necessity forperforming the operation, save that of expe-riment. The individual was a strong, robust

man, with the exception of caries of thehead of the tibia. His health and appetitewere good, when he was admitted into thehospital. He might have lived for manyyears had not the operation been performed,with the comparatively slight inconvenienceof a stiff joint, and it appeared quite un-warrantable to operate in such a case. Afterthe operation the wound was well pluggedwith charpie, and left to nature. The re-sult was, that in the space of a few days in-numerable abscesses had formed beneaththe tendons and skin, all along the externalside of the limb, as far as the hip-joint,which, together with the extensive suppura-tion going on in the wound itself, and thehectic fever that accompanied the forrnatiouof pus, completely ran down the patient inseven or eight days. At the post-mortemexamination the Ii 111 seemed to be burrowedto a great extent, by matter, and the hip-joint was beginning to be affected, whendeath ensued. After the post-mortem, M.Velpeau stated that this being the thirdcase in which he had tried this operationwithin the last few months, and all three ofthem having terminated fatally, he now con-

*

demned the operation as being bad and im-practicable.The operation, although performed by M.

Velpeau, was not countenanced by any ofthe other parisian surgeons. I mentionedthe case to M. Jobert, surgeon l’Fopitat St.Louis, and he said that he did not think theoperation at all practicable.

ON PESSARIES,AND ON THE RADICAL CURE OF

PROLAPSUS OF THE UTERUS ANDVAGINA.

By Professor DIEFFENBACH, of Berlin.

THE use of pessaries, so often employedin the practice of those who devote them-selves to the treatment of the diseases offemales, is attended with so many disagree-able and unfavourable circumstances, thata reform has become absolutely necessary.The method which consists in supporting

the prolapsed uterus, or vagina, by the in-troduction of a solid foreign body, a pes-sary, into the genital organs, is just as rndeand imperfect an operation as the intro-duction of a pessary, or other mechanicalmeans, would be for the cure of prolapsusof the anus. When I reflect on the grpaiinconveniences I have seen arise from theuse of pessaries continued for a great lengthof time, and in many cases actually forgotten,in the genital organs of the female, &c., I amalmost inclined to banish them completelyfrom my practice.

I have frequently seen them produceputrid discharges from the vagina; in otliec

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cases dilatation of the vagina to a most in- vaginal membrane, to the extent of a hand’sconvenient extent; in others, contraction of breadth, came away, and the deficiency wasthe same organ ; and, finally, in other females, soon supplied by luxurious granulations.the still more dangerous accidents of cau- The erythematous inflammation of the restcerous or fungous productions from the of the vaginal mucous membrane had, in

vaginal mucous membrane. Sometimes I the meantime, disappeared, I now thoughtwas able to extract the foreign body with the favourable opportunity was arrived formy fingers, but in many other cases it was replacing’ the uterus, and obtaining cicatri-necessary to break it up with strong for- zation. The former was easily done; Iceps, before the fragments of a stinking, 6!!ed the vagina every day with dry charpie;eacrustated substance, whose composition threw up emollient injections; renewed thecould not easily be determined, was re- bandage daily ; and in three weeks had themoved. Several patients laboured under pleasure of seeing the woman completelyexcessive irritation of the bladder, and when cured of her prolapsus. The cure thusthe foreign body was large, many suffered brought about by nature led me to the ideafor years under obstinate constipation. C. of employing an artificial method, foundedMayer extracted a pessary, composed of a on the principle of reducing the calibre oflarge porcelain tube, which had produced the vagina. The first case of the kind wasulceration of the vagina, and perforation as followsinto the bladder, with one of its edges, from A woman, sixty-five years of age, sufferedwhich the glazing was worn off. On ex- for several weeks under an extremely pain-amining the body of a very old woman, who ful prolapsus of the uterus. For the lastfor many years complained of pain, &c., in fifteen years, whenever the woman walkedthe lower abdominal region, I found an en- about for any time, the uterus descendedcrusted pessary in the cavity of the uterus. beyond the external genital organs, but wasDupuytren once extracted a large pomatum- easily replaced with the hand. When I

pot, which an accoucheur hadintroducedfor saw the patient the left side of the vaginala. pessary; and, on another occasion, a large wall, where it surrounded the prolapsedmetallic, gridiron-shaped body, whose bars uterus, was already attacked with gan.had given passage to fungous excrescences, grene; a line of demarcation separated theThe indolence and negligence of the male dead from the living parts, and dischargedcan only explain those cases in which, not- a quantity of pus. I commenced by remov-withstanding the presence of a pessary, ing, with the scissors, a portion of the mor.females have menstruated, copulated, be- tified membrane, and covered the wholecome pregnant, and even been delivered of parts with compresses dipped in an emol-a full-grown child. Some women actually lient fomentation, without yet attempting toseem to have forgotten that such an instru- reduce the uterus, which the great laxity ofment was ever introduced, others obstinately the genital organs would have rendered easydeny the fact. I have seen two cases of the enough. _

latter ; and, in general, the avowal of em- The dull, greyish appearance of the ex-ploying a pessary or a truss is often more posed surfaces indicated the use of some

painful to a female than the very diseases mild, stimulant application ; they were ac-which demand their use. On the other cocdingly washed, during the day, with anhand, however, it cannot be denied that aromatic infusion, and covered, at night,pessaries and the sponge are sometimes with a stimulating ointment. As soon asuseful, when properly employed by a skii- the whole of the mortified parts had comeful hand; but these cases are few in coiti- away, I replaced the uterus, filled theparison with the former, especially amongst vagina, as usual, with lint, and in a fewthe lower classes of people, who imagine weeks the woman was completely and radi-themselves radically cured the moment a cally cured.pessary has been introduced. Besides the two cases just mentioned, IHaving learned from experience the many have seen five in which prolapsus uteri was

inconveniences of the pessary, I was anx- complicated with mortification of the mu-ious to employ a radical mode of treatment, cous membrane of the vagina. Three ofwhen I was called, several years back, to these cases occurred in the hospital; two insee a poor woman, whom I found lying in my private practice. The treatment, in allbed, with a prolapsus of the uterus. The these cases, was the, same : the separationprolapsed parts were so tumenerl and in- of the gangrenous parts was promoted byflamed, that it was impossible to return internal and external remedies; when theythem; the portion of the vagina surround- came away, I replaced the uterus, and filleding the tumour was partly inflamed and the vagina with lint, moistened with anpartly gangrenous; however, the parts were aromatic infusion; in four cases the partsonly a little painful, and the constitutional cicatrized, and a perfect cure was obtained;symptoms insignificant. The inflamed parts in oue case the left wall of the vagina,were covered with cloths, wetted in an in- where the surface only had been attacked,fusion of camomile flowers, and, at the end remained too relaxed to support the uterusof fourteen days, several portions of the in a complete manner. Even when the snr-

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geon finds it impossible, after the separation diately after the operation, for this onlyof the mortified parts, to return the uterus produces a disagreeable sensation of heatcompletely, I believe he can always replace, in the parts; however, the vagina must beat least, a portion of the organ. plugged when its upper surface has been

After a lapse of eight years I had an op- destroyed by gangrene ; I have sometimes,portunity of applying the method used in however, filled the vagina with charpip,’cases of prolapsus ani, to a case of pro- after the operation, in lymphatic, and, at thelapsus uteri, uncomplicated with gangrene. same time, irritable patients. The cold in-The patient was fifty years of age; the jections are to be replaced in a few days byuterus was easily replaced, but always de- luke-warm mucilaginous ones. Should noscended again, unless supported by some contraction of the vaginal wall he observed,foreign body in the vagina. The patient as cicatrization of the wound advances, thehad employed a great variety of pessaries, latter must be dressed with lint, coveredbut ivas compelled to abandon their use, with some resinous balsam, or frequentlyfrom the pain and irritation which they al- touched with the nitrate of silver.ways produced. The operation was perform- In several cases, after havingreplaced theed in the following manner:-After having uterus, I have performed the operation byemptied the bladder and rectum, I com- merely removing a fold of the vaginal wall,menced by removing, from the left Side of which was drawn forwards withMuzeaux’sthe vagina, a portion of mucous membrane, forceps, and then clipped off; this is much

resembling in size and shape the section of the easier method of the two ; but the sur-a hen-egg ; the small end of the ellipse geon should always be on his guard againstbeing directed backwards, the oval end for- the danger of wounding the bladder or rec-wards, and touching the nymphae. A simi- tum, which might take place if a deep foldlar excision was practised on the opposite of the vaginal parietes was removed closeside. to its base.

After having cleaned the edges of the I never applied sutures when this methodwound, I placed five strong stitches on either was employed. The operation for the cureside,inthefollowingmanner:—thetwoposte- of prolapsus uteri, by removing a portionrior sutures on each side were first applied; of the vaginal wall, is most convenientlythe uterus was then returned to its natural performed by placing the patient in the

position, and the rest of the sutures were common position for lithotomy. The blad-finished ; had they all been applied in the first der and rectum must be previously emp-instance, it would, perhaps, have been im- tied. The surgeon should also take carepossible to return the uterus afterwards, to ascertain how far these two organs may

If we except burning pain in the vagina, be displaced by prolapsus uteri, by intro-and a moderate febrile movement, the symp- ducing his finger into the one, and Desault’stoms which followed this operation were catheter into the other. The introductionnot very remarkable. The patient under- of the catheter is the more necessary, as inwent an antiphlogistic treatment, and cold a great many cases the bladder is sur-

injections were thrown up every hour into charged with urine.—Berlin 1Iled! Zeitt(ilg-,the vagina. On the third day, however, the No. 31, 1836.woman complained of severe pain in the

vagina, probably depending on the sutures.I was afraid to employ the speculum, forfear of tearing through the edges of thewound, and therefore introduced a pair of A WOMAN was admitted into the Hôtelscissors along the index finger, with which Dieis with considerable swelling of one ofI divided two sutures on either side ; this the tonsils. All those who saw the womanproduced considerable relief; on the fifth before the arrival of Dupuytren, consideredday I removed some more, and the two the case to be one of simple inflammation uflast came away without aid on the sixth the gland. He came, and gave it as hisday. opinion that a cyst existed in the tonsil, andSince this time I have had such frequent that there were other cysts in some part,

opportunities of performing the operation more or less distant from the throat, whichnow described, that I should extend this had a great tendency to inflame, by a kindmemoir beyond measure, were I to notice of sympathy which united them. The cystthem even cursorily. In those operations was removed, to the great astonishment ofwhich were subsequently performed, I appli- those assembled. Next day erysipelas ofed a smaller number of ligatures, commonly the face appeared, and pain in one of thetwo, at most three ; in several cases none at kidneys. "It is in one of the kidneys,"all; for the edges of the wound frequently said the surgeon, "that the second cystcame into close contact with each other exists ; it is inflamed, and we are in dangerafter the reposition of the uterus. In cases of losing our patient," a circumstance whichwhere the parietes of the vagina are very happened,notwithstanding the best-directedirritable the suture is injurious. It is un- treatment. The inspection after death con-necessary to fill the vagina with lint imme- firmed the accuracy of his diagnosis.