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24. Bowels hdve been opened three timessince yesterday ; slept indifferently, butfeels much improved this morning ; pulse104, small ; occasional vertigo.

25. The pain in the shoulders has re-

turned, and disturbs his rest; tongue clean ;bowels costive. To take half an ounce ofcastor oil immediately.

26. Improving rapidly.27. Passed an indiift-rent night, but is

much better this morning. Says he is get- Iting stronger, and he may fairly be pro-nounced convalescent.

RECOVERY FROM A WOUND OF THE BRAIN,WITH LOSS OF CEREBRAL SUBSTANCE.

J. P., aetat. 3, a soldier of the garrisonof Coblentz, received, on the 6th of August,1829, a gun-shot wound in the head. Twohours after the accident, he was broughtinto the Military Hospital in a state of stu-por, with inclination to vomit. His counte-nance was pale and collapsed ; his answerswere slow and incoherent ; he complainedof headaeh, great lassitude, general uneasi-ness, and darkness before his eyes ; breath-ing was very slow ; the lower extremitieswere cold and paralyzed. He had lost abouttwo pints of blood. There was a lace-rated transverse wound at the occiput, ofabout one inch and a half in length; thehaemorrhage was nearly arrested, but a con-siderable quantity of blood had accumulatedunder the edges of the wound, which wasimmediately enlarged, and the blood evacu-ated by a free incision through the laceratedscalp. The skull having thus been laidbare, a large fracture was found between theexternal occipital prominence and the lamb-doid suture, with considerable depression.There were a great many fissures in variousdirections, and some of the fragments hadbeen driven below other portions of the skull,with such a violence, that it was found im-possible to extract them. 1o rupture ofthe dura mater could be discovered, although,during the examination, a small portion ofcerebral substance, of the size of half afilbert, was found on the ground where hewas wounded. Trepanation having been de- z,cided upon, the patient, a very robust man, I,,was first ordered to be bled, which was,however, found impossible, on account of thegreat collapse of the vessels. The opera-tion did not offer any-thing of interest. Twolarge pieces of skull were removed, andseveral smaller fragments extracted, afterthe removal of which, a rupture of abouttwo-thirds of an inch was discovered in themembranes. There was no extravasationunder the dura mater ; not much blood was ’,lost during the operation, during which the J i

patient continued in a comatose state. Thewound was filled with a piece of sponge,and lint, with compresses, was looselyplaced over it; internally, the infusion ofarnica with salts was administered; thehead was kept cool with vinegar and water,and the bowels freely moved by injections.A short time after the operation, the patientseemed to fall into a tranquil sleep, which,with slight interruptions, continued till to.

wards the evening, when he awoke andcomplained of blindness; the pupils weredilated, though not quite insensible. The’ night was passed rather restlessly, and thepatient repeatedly vomited a large quantityof bile. On the following morning a slightreaction had taken place, the pulse had risen,the skin was warm, and the paralysis of thelower extremities had disappeared ; the pa-tient complained of headach and confusionof ideas ; there was also some paraphrosyne.Thirty leeches were applied to the head,after the application of which he seemed tobe relieved. The rest of the day was passedpretty tranquilly, and he complained only attimes of pain in the orbit. The night wasagain very restless, and in the evening thedressings were found tinged with blood, audthe w<)und of the scalp began to suppurate.The pulse was full, but within a short umefell again. In the afternoon the patientwas more clear in his ideas than he hadbeen since the accident, and sight appearedalso to be restored in some degree. Towardsthe evening twelve leeches were applied,but without much relief, and the followingnight he was again very restless. On the 9th,the dressings were removed for the first

time ; a small portion ot cerebral substancebad protruded through the rupture in thedura mater ; the suppuration was rather

profuse ; in other respects the wound bada good appearance. It was again looselyfilled with a piece of sponge, and coveredwith lint and compresses, dipped in a so.lution of chlorate of lime. On the llth,the prolapsed cerebral substance was founddark-coloured, of a fungoid appearance ; theappearance of the wound was good. The

general state of the patient also began toimprove, he became collected, and sleptmore quietly, and sight was almost com-pletely restored. During the followingdays, the cerebral fungus was found gradu-ally to protrude, and it was accordinglythought necessary to apply the dressingsrather more tightly. On the 14th, the pro-lapsed portion of the brain was nearly ofthe size of half a walnut, its surface wasgreenish, and it caused a very offensivesmell. It was dressed with lint dipped inthe solution of the chlorate of lime, whichwas also repeatedly sprinkled over thebandage. On the 16th, the protruded masshad still increased, but bad in other respects

479

not changed, except that the smell was lessoffensive. The compresses were again ap- Iplied more tightly, in order to prevent the ifurther protrusion of the fungus. During

I

the night of the 17th, however, the patient I IIwas suddenly seized with violent delirium;the bandage was tinged with blood, and iwhen it was removed the cerebral funguswas found to have attained the size of asmall apple, and to pulsate violently. The Iwound was now simply dressed with cerate, Ithe head kept cool with fomentations, andthirty leeches were applied to the templesand behind the ears. The in fusion arnicas wasnow omitted, and a simple saline mixture

given in its stead. Is the morning, the Ipulsation in the protruded mass was stillvery violent, but the general state of thepatient was better, and he had had a fewhours’ tranquil sleep. On the 18tb, the

fungus had not become larger, and as itssurface had evidently become gangrenous, asmall layer of it, about two drachms in

weight, was removed, and the rest touchedwith nitrate of silver, and dressed with a de- Icoction of oak-bark; neither of these opera- ’Itions caused any pain, and as on the fol- Ilowing day the whole of the fungus ap-peared to be gangrenous, it was entirely re-moved, first by the ligature and then by theknife; a considerable quantity of saniousmatter was discharged from the bottom ofthe fungus, the whole weight of which wasabout eight drachms. The wound wasdressed with the decoction of oak-baik, andtonics were given internally. On the 20thand 21st, the patient went on favourably;on the 83d, the wound, from the removal ofthe fungus being still of gangrenous ap-pearance, was covered with powdered barkand myrrh ; no protrusion had taken place.The external wound was gradually healingat its chcumferenee ; sight was almost re-covered, and the use of the lower extre-mities perfectly restored ; the bowels wererather costive, and required the continueduse of glysters. The mental faculties, thoughmuch improved, were still in some degreeaffected, he was often thoughtless and in-atteutive ; his memory was good but ratherslow, &c. On the 21st, the wound of thebrain had a much better appearance, the

discharge was much less and of better qua-lity ; the flaps of the scalp begau to healtowards the centre, and had almost entirelyunited amongst one another. During thefollowing days no change took place in thestate of the patient, except that at thewound of the brain a small abscess formed,which broke and discharged a small quan-titv of healthy pus. The wound of thescalp went on favourably, and the flapsfirmly united to the subjacent parts, so as toleave only, in the middle, an aperture ofabout an inch in depth, in consequence of

the removal of the bone and the loss ofcerebral substance. On the 16th of Sep-tember, the aperture was almost entirelyfilled up, and closed bv the cicatrization of .

the external wound ; the general state ofthe patient was good, his faculties were en-tirely restored, he had gained in strength,&c. ; sight only was still rather impaired,particularly that of the right eye. On the21st, the wound was quite healed ; the cica-trix was of the form of a small quadrangulardepression, and, with the exception of theweakness of the sight, he felt perfectly well,so that, after a few weeks more, lie was en-abled to leave ttie hospita1.- GTaefe u.

WaltheT’s Journal.

ELECTION BY " CONCOURS"

At the Parisian Faculte de liedecane.

’fHREE public " concours" will be openedat Paris on the first Monday of Februarynext, for the Professorships of Surgical Pa-

thology, Physiology, and Natural Philoso-i phy, at the Faculte de Itledecine. The can-

didates are to be subjected to the followingtests of qualincation :-1. They are each to publish a dissertation

on the science of which they wish to obtainthe chair, developing their plan of lecturing.

8. A thesis, the subject of which is deter-’mined by lot; this is to be written in

French, and will be publicly read by thecandidate.

S. A lecture of one hour’s duration to bedelivered after twenty-four hours’ prepara-tion.

4. A lecture of an hour, after three hours’

preparation.5. A critical examination of the former

writings and "concours" of the candidate.The election, which will take place imme-

diately after the last sitting, is to be made

by a jury consisting of twelve jurors andthree 11 sul3pl6ans," of whom eight jurorsand two" suppleans" are to be appointedby the Faculty, and the rest by the " Aca-d&eacute;mie des Sciences."

.

DISEASE OF THE ELADDER.

AT a late meeting of the Medico-PhysicalSociety ot Florence, Dr. Betti communicatedthe case of an elderly man in whom, in con-sequence of complete obliteration of the

urethra, the urine was discharged throughthe navel; it had been supposed that theurachus was open; but on post-monten2

examination it was found that there was anulceration of the bladder, from the fundus

480

of which, up to the navel, an abscess hadformed, and that this cavity had served forthe passage of the urine.

Dr. Nespagli mentioned the case of a fe-male, at the post-mortem examination ofwhom the upper portion of the bladder wasfound wanting, and had been supplied byadhesion of part of the colon to the remain-ing portion of the bladder, so as to completethe cavity. The patient had not sufferedeither dysuria or incontinentia urin&aelig;.&mdash;Annali Univ. d. Omodei.

LOCAL MEDICAL ASSOCIATIONS.

To the Editor of THE LANCET.SIR,-Allow me earnestly to recommend

to that portion of the medical professiondescribed as general practitioners, throughthe only channel of sufficient circulation tomake the advice available, to form them- Iselves into local associations like those ofLeeds, Newcastle, or Glasgow, with a viewto their ulterior general combination, or atleast general co-operation. Whatever maybe the advantage of the " MetropolitanSociety" it cannot for a long time, if ever,embrace a sufficient number of members torender it efficient for all the purposes it

professes to have in design..Nothing can

be more easy of accomplishment, or moredesirable in the end, than the general prac-titioners throughout the country formingthemselves into bodies of twelve or fifteen,raising a small fund (a guinea each memberannually) for the purchase of books to go theround of the members, like social reading so-cieties. The meetings once a fortnight ormonth at the house of each member alter-

nately, would greatly tend to promote mu-tual good understanding, and would even-tually,prevent those hostile collisions whichare so opposed to the comfort and interestsof this class of the profession, a feeling ofcommon interest and unanimity of purposewould cement the members, and render theendeavours to obtain an amelioration of ourcondition successful by their being com-bined. I am, Sir, &c.,

A GENKRAL PRACTITIONER.

TO CORRESPONDENTS.A communication has been sent to THE

LANCET Office for J. S. C.Mr. Dermott’s letter shall appear next

week.A Puyil of 5t. George’s cannot expect

&deg; Apis" to display much activity at thisseason of the year.Thanks to Scriptor, but he has been mis-

informed ; there are no new arrangements.It is utterly impossible for us to insert

one-fourth of the letters we are in the habitofreceiving.

BOOKS RECEIVED.

Inquiries concerning the IntellectualPowers and the Investigation of Truth.

By John Abercrombie, M.D., &c. Edin-

burgh: Wauaii and Innes. London: Whit-taker. 1830. 8vo. pp. 435.A Letter to the Metropolitan Commission-

ers in Lunacy ; containing some strictureson the Act of Parliament, and Observationson their Report. By J. Haslam, M.D., ofthe Royal College of Physiciaas of London.London : Whittaker. 1830. pp. 24.Two Lectures on the Study of Anatomy

and Physiology, delivered at the opening ofthe Medical School, AIdersgate Street. ByJones Quain, M.B., Lecturer on Anatomyand Physiology. With Plates. London:

Simpkin. 1830. pp. 44.

ERRATA.In Dr. Nagle’s paper, p. 395, co!. 2,

before " foetus in utero," add life or death ofa; p. 393, col. 2, 1. 3, after ’&deg; previous,"add to her adntissioya; p. 397, col. 1, after" uninterruptedly," add nei-oss the ante-rior surface of the uterus.

In Mr. Dermott’s paper, page 412, col.1, line 23 from the bottom, dele the comma;line 12, after &deg; canal " insert and blood;line 10, for "If it is true," read It is true.Col. , line 29 from top, for "becausewithout," read because they aoe without.

In Mr. Ward’s letter, p. 444,1. 20, for" with," read without 1. 46, for 11 induced,"read increased ; 1). 445, 1. 13, for " back,"read neck; !. 17, read These remarks arenot intended to condemn," &c.; 1. 20, for" affected," read effected.Page 446, col. 1, line 10, for 11 ex-,tinin.

ing’," read drawing.