248

After-death Appearances.The body was examined twenty hours

after death.Blood was extravasated under the scalp

covering the left parietal and temporal bones;dura mater healthy and entire ; arachnoidopaque and thickened; left hemisphere ofthe brain healthy; the under surface of themiddle lobe of the left hemisphere (the sideopposite the part of the head injured) wasfound lacerated to the extent of an inch ;blood was effused into its substance, andthere was about an ounce of blood lying onthe dura mater, under the brain at thispoint.On examining the skull, a fracture was

detected, extending from the temporal angleof the left parietal bone, just at the partcorresponding to the external ecchymosis,through the left temporal bone, across thegreat ala and body of the sphenoid bone tothe foramen lacerum anterius of the rightside ; other organs healthy.

ST. BARTHOLOMEW’S HOSPITAL.

HERNIA.

George Sims, admitted Oct. 21, under thecare of Mr. Vincent. He was sufferingfrom all the symptoms of strangulatedhernia, but was in such distress that no col-lected history of his case could be obtained.The taxis having proved ineffectual in re-

storing the intestine, Mr. Vincent operatedat ten at night. The hernia was a femoralone, about the size of an apple, and afterthe crural canal was laid open, Poupart’sligament was freely divided, and the intes-tine returned certainly within the confines ofthe abdomen. The operation afforded norelief to the symptoms. He was ordered anenema, and ten grains of the calomel andjalap pill.

22. No relief; the bowels have not beenmoved ; occasional vomiting continues ;great tenderness over the abdomen ; hot anddry skin ; pulse very irregular and unequal.We counted it once 96, and within an hour140. He is almost unconscious. Twenty-four leeches to the abdomen ; warm bath ;enema.

Bl’andy, half a pint;Calomel, ij grains ;Opium, 2 grain, at once.

Vespere. Warm bath.Calomel, iv. grainsOpium, grain.

23. No improvement. He was orderedanother half-pint of brandy, and an enema.

Calomel, ij. grains;Opium, iss. grain.

This pill was repeated in the evening, andhe had another warm bath.

24. All the symptoms exasperated; hehas a convulsive hiccup ; great restlessnessfever; pulse low and irregular. He is al;

most totally insensible ; eyes glazed, andlips livid. No further means were adopted,and he died on the 25th.

The friends would not allow a post.mortem examination of the body.

VENTRO·VAGINAL FISTULA.

There has been a case of this disease inthe hospital during the past week, underMr. Stanley. The disease commenced manyyears ago. It appears the woman’s firstlabour was very lingering, and sloughing ofthe vagina followed. A small portion ofintestine then descended into the vagina,but not to such an extent as to prevent con.ception, for she afterwards bore six chil.dren. A pessary was then employed, whichshe wore till it produced retention of theurine, for the relief of which she was ad.mitted into the London Hospital. Someoperation was performed to extract thepessary, by which the aperture in the vaginawas increased ; and, since then, whenevershe stands up, large portions of intestine passthrough the os externum. If no bandage beapplied, they are of the size of a large child’shead. Mr. Stanley wished to pare the edgesof the fistula, and thus endeavour to promoteeither adhesion, or great contraction of theopening. She ’refused, however, to submitto the operation, and was accordingly dis.charged.This case is interesting from its rarity,

and the extent of the fistula. It must he

exceedingly uncommon, as Madame Boivin,in her work on the diseases of the uterus,does not refer to it.

SCALD OF THE GLOTTtS.ńBRONCHOTOMY.

On Friday evening, October 18, about fiveo’clock, a child, three years old, namedWhitehead, was brought in, after havingswallowed boiling water, or inhaled itssteam. The mother had been in the habitof giving it tea from the spout of a teapot,which had led the child to apply to thespout of a teakettle. There was difficultdeglutition, pain in the throat, and all thesymptoms of croup. The mother would notallow the child to remain in the Hospital;but finding it was getting worse she broughtit again about eleven at night, with all thesymptoms alarmingly aggravated. One ofthe surgeons was sent for, but before hearrived the danger of asphyxia was so immi.nent, that Mr. Travers, the house-surgeon,performed the operation of bronchotomy.Immediate relief was afforded ; but the childdied about ten on Saturday night.

This is one of a class of cases where theearly performance of bronchotomy is impe-ratively called for, the fatal symptoms beingproduced, in the great majority of cases,not by the local injury which such accidentsmust produce, but by the effects on the glot-tis impeding the transit of air, thus produc-

249

ing an impediment to respiration. The pa. was brought to London, and was led into thethological changes are excoriation of the operating theatre on Saturday, just threemouth and fauces; effusion of serum into the weeks after the accident occurred. She wassubmucous tissue around the glottis; many first placed in a semi-recumbent posture, asmall vesicles on the surface of the mucous towel was fastened round the wrist, and amembrane; with vascularity, and a coating cord appended to this was passed through aof lymph, or viscid mucus, on it. pulley fixed just above her head. Thus theMany cases are recorded of success under arm was pulled directly upwards ; with the

these circumstances, even when death was exception of great suffering, no effect wasat hand; but if success is to be expected produced-indeed, the attempt appeared awith confidence, the trachea must be opened very ill-directed one, for though, by this posi-before cerebral congestion, or effusion into tion of the arm, the deltoid and some of thethe pulmonary tissue, has occurred. In capsular muscles are relaxed, yet little effec-the case before us there is little doubt, that tive means being adopted to fix the scapula,had the woman submitted her child, at first, as the cord was tightened, so was the pa-to its performance, a different result would tient raised, and the weight of her body be-have ensued. came the principal counter-extending force.

- After persevering thus, for some time, theHYDROCELE.-INJECTION OF PURE PORT WINE. plan was altered; a large pad was placedA man named Mackenzie, aged 50, ad- in the axilla as a fulcrum, and the pulleys

mitted Oct. 11, was operated on for hydro- so fixed, that the arm was pulled in a linecele on Saturday, Oct. 12. The disease parallel with the body. The bone returnedcame on six years ago, without assignable almost immediately with a snap. This is a.

cause. He was tapped two years ago, but mere modification of Sir Astley Cooper’sthe sac was not injected. On admission he plan of the heel in the axilla, which is farwas suffering no pain, but merely came in the most effective in the generality of cases.to be relieved from the inconvenience pro- -

duced by thp size of the tumour, which was STRANGULATED CONGENITAL SCROTAL HERNIA.

nearly as large as the head of a small infant. OPERATION.The surgeon introduced the trocar without On Saturday, October 19, a young manpreviously dividing the skin. This is gene- was admitted, suffering from all thesymp-rally omitted, but it prevents the trocar en- toms of strangulated hernia. He was carry-terIng with a jerk, and thereby removes all ing a sack of potatoes the night before, indanger to the testicle. About half a pint of the street, when he suddenly felt severefluid was evacuated, and then port wine, griping, and was troubled with flatulence.undiluted, was injected. It was removed He vomited soon after he got home, and theas soon as pain came on. He has had no

symptoms continued to increase till his ad-more local tunammahon or constitutional mission into the hospital. He then denieddisturbance than was to be looked for, and having, or ever having had, any hernialwent out, probably, with a radical cure. profusion whatever. On examination, aOn the same day Mr. Stanley, also, in- scrotal hernia, however, was discovered,jected pure port wine, and with similar when he declared he never observed tbe

favourable results, his patient having been tumour before. The taxis having proveddischarged on Saturday the 19th. unsuccessful, though all the ordinary means- -

were used, the man was brought into theDISLOCATION OF HUMERUS INTO AXILLA.-RE- operating theatre, and Mr. Vincent pro-

DUCTION AFTER THREE WEEKS. ceeded to perform the necessary operationA woman, aged about 50, was admitted for the relief of the incarcerated bowel.

last week with dislocation of the humerus The incision was made in the usual direc-into the axilla. It was a well marked case, tion and extent, when, after laying bare andthere being elongation of the arm, a hollow dividing the coverings of the sac, it wasunder the acromion, flattening of the shoul- found that the hernia was a congenital one ;<ler, elbow protruded from the side, and the the tunica vaginalis testis forming the sac,round head of the bone could be felt in the to which a considerable portion of omentumaxilla. These signs may all exist in fracture was adherent. It was evident that a largeof the acromion, or of the neck of the scapula, portion of the strangulated intestine had re-but then the arm is easily replaced, and cently descended, and been the cause of thecrepitus produced, the arm again falling symptoms. The intestine was not gangren-when our support is removed. It is said ous, but very red, in many parts purple,this dislocation has been mistaken for frac- from intense injection, distinctly in a stateture of the neck of the humerus; but here, of active congestion. No great difficultyinstead of elongation, we have shortening occurred in returning it, after the division ofof the limb, and in place of the round head of the stricture, but the termination of thethe bone, we feel the sharp, rough, or irre- operation was delayed for some time, as

gnlar end of the shaft in the axilla. Mr. Vincent had removed the omentumSeveral unsuccessful attempts at reduction which adhered to the sac, and it was neces-

having been made in the country, the woman sary to tie several vessels. Not much bloodNeo. 845. S

250

was lost, but the poor fellow was carriedout much exhausted. No clinical remarkswere made, which is much to be regretted,as the case was admirably fitted to illustratethe treatment to be pursued with regard tothe omentum, after operations for strangula-ted hernia. A number of students cannotbe expected to know, by intuition, what ispassing in the mind of the surgeon beforehe determines on the practice to pursue in acase on which such difference of opinionobtains among surgeons.

20. Feverish ; thirsty ; bowels not moved;Some tenderness of the abdomen.

Sulp. of Magnesia, two drachms ;Peppermint Water, one ounce. A draught

every two hours.Sixteen leeches to the abdomen, and warm

fomentations,21. In the morning, saline effervescing

draughts were ordered, and twelve leechesto the abdomen. At noon, he was still

feverish; face flushed ; very thirsty; and

suffering from pain in the abdomen ; twenty-four more leeches were ordered, and, thoughthe bowels were open, a dose of calomeland jalap.

23. The pain, tenderness, and fever, con-tinue ; pulse 135; bowels freely open.Continue medicines.

After this all the symptoms continued in.creasing, and no further means were adopted.He died on the 24th.

THE LANCET.

London, Saturday, November 9, 1839.

LAST NEW SCHEME FOR INJURING THE

A MEETING has recently been held, in thetheatre of the Literary and Scientific Insti-tution, Aldersgate- street, to consider thepropriety of forming a Self-supporting Esta-blishment, for the reception and cure of sickpersons of the middle classes of both sexes.

Dr. ARNOTT was in the chair. The institu-

tion is to be called a Sanatorium. Dr. SOUTH-

WOOD SMITH, the projector, explained thenature of the plan to the meeting. Its pro-

fessed object was to apply the principle ofco-operation for the purpose of securing, at acheap rate, the accommodation required insickness. " The classes of persons," he said," for whom it was designed were enumerated" in the prospectus, viz., young men who" pursue education, science, and the fine arts,

as professions; who are engaged in the

"offices and courts of law, and in the

"schools of medicine, for the purpose of" completing their professional education;" who are employed in the various govern." ment offices, in the legal and medical pro.fessions, in the church, in merchants’

counting-houses, in banking-houses, and" other large establishments; and unmarried&laquo; women who pursue education, literature," music, and the fine arts, as professions, or" who, whatever be their occupations, are

" merely residents in families, but not pro." perly parts of those families. These per.

&laquo; sons, though not rich, though earning" their subsistence by their own exertions

" (often exceedingly laborious), were all ofthem willing, and most of them able, to

pay moderately for the assistance theyneeded when afflicted with disease. But

their own dwelling-houses, or rather their94 apartments in such dwelling-honses, were"in general destitute of the accommoda.

&laquo; tions which were indispensably necessary" in sickness, not to say of the conveniencesand comforts which lessened its severity and" diminished its danger. To supply these ac.

commodations, it was proposed to found" an establishment on a seale of moderate" magnitude, that is, capable in the first in’" stance of containing from eighty to onehundred beds together, with apartments" that may be suitable for convalescents. In

" this establishment it was proposed to com-" bine every thing that science could suggestand art accomplish, that was really con-" ducive to the safe, rapid, and effectual

" cure of diseases. By this was to be un-

" derstood perfect ventilation, exact adjust." ment of temperature, proper regulation of

" diet, regular administration of medicine;" in a word, the strict and constant perform-" ance of every thing that came under the

" very comprehensive term-good nursing."The establishment to be supported by

an annual subscription of a guinea, whichwill constitute a member, and by the pay.ment, on the part of every patient, of a cer,tain sum weekly during his residence. The

weekly sum to be fixed from time to time