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the tumour waseffected, the fasciaewere then divided, and at lengththe hernial sac, when severalounces of fluid, slightly coloured,escaped. Upon introducing thefinger within the sac, it was foundthat there was no adhesion there,or stricture at the ring ; and itwould be difficult to account forthe causes which prevented its re-duction by the taxis. The intes-tine was apparently very healthy,but was convoluted or twisted up,and " it appeared to be the opi-nion of the surgeons, that thiscircumstance opposed its reduc-tion."

10. Has passed a tolerable night,is free from pain, and has had noreturn of the sickness; his tongueis still crusted, white, and dry ;and his pulse, though increased afew beats in frequency, was stilllaaguid and weak. He was or-dered to have Ex. ColocynthidisComp. gr. x. 3tiis hoi-is donec al-vus dejecerit. During the day, hehad several copious stools, andhad a great desire for food ; hisspirits were good ; and his hopesof recovery confident.

11. There was a slight pain ortenderness on pressure in the left

hypochondrium; pulse slow andirregular, but rather fuller ; bow-els open ; tongue still furred, butmore moist.

Hirudines sex, hypochondriodextro.

. Pulv. 117ecac. com. grana sex.)%!. Æth. nit. drachmam di-

midiam.

Liq. ammon. acet. drachmas

quatuor.Aquœ destillatœ, unciam—fiat

haustus, Gtiis horis capi-endus.

12. To-day there is but little

alteration ; pulse still slow and

irregular; pain in the left hypo-chondrium rather increased, andthere is a slightblush of erythemain the neighbourhood of the

wound ; tongue still furred, butmoist ; bowels not open since

yesterday.Capiatur:

Haicstus sennce compositi, un-ciam et dimidiam ter die.

The wound was examined, andappeared to be tolerably wellumted at the upper part ; how-ever, a small quantity of matterwas discharged.

13. Last night the condition ofthis man did not indicate anychange for the worse; his pulsewas already observed small andintermitting, and his other symp-toms much the same as on the

prececling days; about 4 o’clock,A.M. however, he died.

Inspectio cadaveris. That por-tion of intestine which had form-ed the hernial tumour lay-foldedtogether, and adhered by coagu-lated lymph, and was approachingto a state of sphacelation ; the in-testines were more vascular thanusual, and slightly distended withair ; the omentum had descendedinto, and adhered at, the neck ofthe sac, near to which also theperitoneum was inflamed. Therewas a hernia on the other side, towhich likewise the omentum, ad-hered : there was an extensive

suppuration between the tendonsof the external and internal ob-

lique muscles.

WESTMINSTER HOSPITAL.Operations.

Saturday, Oct. 16. Mr. WHITE

operated for ascites upon the sameman who had undergone the ope-

126

ration of paracentesis abdoministhis day month. The water was

again collected in almost the samequantity as before, and so as to

obstruct the respiration to a con-siderable degree.The trocar was introduced into

the linea alba, an inch and a halfbelow the umbilicus, when a gal-lon and a half of clear serous fluid,of a lemon colour, was evacuated.During the period in which thefluid was flowing, Mr. WniTE

placed a thermometer so as to beimmersed in it immediately on itsevacuation, and the mercury stoodat 98 ; another was put into themouth of the patient, and foundto rise no higher than 930.

The accidents admitted thisweek are: three fractured arms ;one man burnt on the arm, hip,and foot, by falling between thehot flues of a gas manufactory;and a woman brought’in with anapoplectic fit ; the particulars ofwhich will be given in our nextreport.

After the operation, a few mi-nutes remaining unoccupied, SirANTHONY CARLISLE informed the

pupils, that if they would givehim their attention, he would offersome observations which he

thought might be of use in theirstudies. All being silent, he be-gan in the following manner : " Ihave always, gentlemen, at the

beginning of a season, been ac-customed to inform those attend-

ing this hospital some thingswhich I consider may be service-able to them in their progressin study, as young men and aspractitioners, aclvaitageous intheir future lives : and this I havebeen more readily induced to do,from thinking it my duty, as asurgeon to this institution, to giveall the information in my powerto those who become its pupils. J I

do not mean to insinuate by this,that the other surgeons neglecttheir duty by not doing the same;for each of them acts in the man-ner which, according to his judg-ment, will best promote your in-terests ; but I think there are

some points on which a youngman requires information, as to

the mode he is to adopt during hisattendance in town upon the bos.

pitals. I have always observedthat the mind of a young man hasa tragic turn, if I may so expressmyself ; that he is fond of run-

ning about after operations, oftenperformed as a last resource, and

frequently unjustifiable in them-

selves, instead of attending to themore useful, but less strikingsurgical cases of every day occur-rence. This mode of proceedingis one which produces very littlebenefit to a medical man as an

operator, and often great evil asa general practitioner ; for itcauses him to lose his time by at-tending to them, and also makeshim neglect those cases fromwhich much knowledge may begained, but which he passes overas things either useless in them-

selves, or which may be learnt atany time when he is in practice inthe country.

Operations, indeed, are but sel-dom wanted in general practice;not oneman in twenty living in thecountry ever performs them, andeven in town, unless a man is an

hospital surgeon, they very rarelyfall under his care. A very emi-nent surgeon of London, a man ofvery large practice, of great ex-perience and no less ability, toldme before his death, that he hadnever performed an amputation,and only one cancerous breast, inhis whole life, had he extirpated.Those things to which I would

have you pay particular attention,

127

are of general use, and of frequentoccurrence, for on them the sur-

gical fame and fortune of most ofyou must be founded; come down

. to the hospital and examine thepatients yourselves, and you maybe certain of gaining the advan-tage of it.

By what I consider to be au ex-cellent regulation of this hospital,every pupil has a right to the of-fice of dresser in regular rotation,but I am sorry to say this privi-lege has been much neglected ; Iwoulrl advise you not to fail in

availing yourselves of it; for onthe skilful application of a ban- Iuage much of the success of acure depends ; and you ought, inregard to your own interests tomake yourselves masters of thispoint, for it is a thing of whichthe bystanders can form an accu-rate judgment, not like the moreintricate operations of medicine,where all is hidden under the veilof obscurity from the patients andthose around them, and where al-most any blunder may pass unper-ceived; but here it is very different,and a good opinion of a practiti-oner is often formed by the neatapplication of a roller, or a badone by the unskilful arrangementof a bandage in bleeding ; for bythese circumstances do peopleform their judgment of the skillof the operator.

-

In your ideas of the powers ofremedies do not be too sanguine,for you are liable to continual dis-

appointment. It is said there arethree stages in the life of a medi-cal man, in all of which his opi-nion of medicine varies; when hefirst begins to practise, he suppo-ses he has only to give physic to

perform a certain cure, but to hissurprise he finds that, for all hisskill, some of his patients die ;

that at the bedside of a Sick per-son, it is not so easy to cure as

might have been expected fromthe lectures of his teacher, whereevery thing is nicely arranged,where first are the symptoms re-lated, then the remote, next theproximate causes, the diagnosisand prognosis follow, and finally,the cure. All this seems very easyto do, but in practice he discovershis mistake, and after followingthe lecturer and nosologist, he,notwithstanding all, loses two orthree patients ; he turns a sceptic,and disbelieves in the virtue of

physic altogether.In this blind state he goes on,

only giving something to amusethe patient, which he thinks willprove of no hurtful quality, untilat last, either in his own practice,or in that of his neighbours, henotices some cases which he thinkswere benefited by the medicinestaken/and where the patientwouldhave died without them.

Reflecting on these, the third

stage follows 3 here he again be-gins to have a better opinion ofphysic, and he finds that, by a ju-dicious treatment, many diseasesare happily terminated, whichwould have ended otherwise with-out them ; so that, in progress oftime, he becomes an experiencedand good, though cautious, prac-titioner."

Sir Anthony would have pro-ceeded farther in his remarks,but for his being interrupted bythe business of the hospital Mr.Guthrie requesting him to see a

patient who was waiting for hisopinion.

In a former Number of the Lan-cet, it is mentioned, that publicconsultations, upon the proprietyof operating, were first instituted

128

by Sir Astley Cooper, at the Bo-rough Hospital ; this, however,we beg to state, is incorrect, forthe public consultations on suchoccasions were first introducedat the IVestrninster Hospital, andby Sit Anthony Carlisle.

TO CORRESPONDENTS.

We do not recollect having receivedany Letter from Mr. R-e.

The article from our valued Corres-pondent, who has promised ’ more fromthe same hand,’ shall certainly appear;probably in our next. He will ob-serve that its insertion to-day wouldbe premature.

We have to thank many Correspon-dents for much valuable information,of which we shall av.al ourselves in

future Numbers. -

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