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opened. A director was carried throughthe aperture, and the thyreoid cartilage di..vJded on it in its whole iengt!); a violent,but short attack of cough followed this

part of the operation ; when it had subsided,some attempts were made to extract the

needle, but the extreme agitation whichfollowed each introduction of the forceps,made M. Blandin desist from them. Thewound was dressed with a piece of adhesiveplaster, with an opening in the middle for thepassage of air. The act of swallowing wasnow attended with much less difficulty,but thefluids escaped, for the most part, through thewound. The thread had, during the ope-ration, been involuntarily swallowed. Thenext morning the needle, an inch and a

half in length, was found fixed in the plaster,and easily extracted. From this time allthe symptoms abated, aud the wound slowlyhealed, at the end of September, a smallfistulous opening, and some hoarseness, stillremained.—Journ. Hebdomad. de Médec.

HOTEL DIEU.

CATARACT.

lN twenty-one cases of cataract, whereM. Dupuytren performed keratonyxis, thefollowing were the results :-of the pati-ents three were under ten, seven under

fifty, and eleven above fifty years of age ;in eleven cases the operation was followedby immediate success ; in six, the patientsrecovered their sight after a month ; in fourcases only the operation failed ; in two ofthem amaurosis, in one opacity of thecornea, and, in another, inflammation andatrophy of the eye ensued.

ANEURISM OF THE INNOMINATAAND CAROTID.

[Communicated by Mr. WARDROP.]

Aneurism nf the Innomiata and Root of theCarotid, successfudly treated by T’ying the

Carotid Artery.

By D. EVANS, Esq. Surgeon at Belper,Derbyshire.

WILLIAM HAi.1,, mtat. 30, a butcher andhorse-dealer, an athletic and spirited young-man, about five feet six inches. high, hasbeen accustomed to laborious exercise, fre-quently riding from 70 to 100 miles a day,and has always enjoyed excellent health,until the appearance of the following symp-toms :-About 14 months ago he was seizedwith shortness of breath, troublesome cough,

and tightness over the chest, after much ex-ertion, especially in walking fast up a hill.These symptoms continued until the 6thMarch, when he had an attack of bronchitis,which he attributed to cold. His expectora-tion was copious, consisting of mucus

slightly streaked with blood, and his coughcame on in violent paroxyms, which werefollowed by a sense of suffocation.On the 10th of March, afler a fit of

coughing, a soft pulsating tumour, aboutthe size of a walnut, suddenly made its ap-pearance behind, and extending a littleabove the right sterno-clavicular articula-tion, and covered, externally, by the sternalportion of the sterno-mastoid muscle. Thetumour was greatly diminished by firm pres-

, sure, but could not be made to disappearentirely.The pulsation of the tumour, which was

synchronous with that of the heart, wasl increased in force by piessure upon the

right subclavian artery, and was diminished,and sometimes completely arrested, by pres-sure upon the right carotid, above the tu-mour. The pulsations of the right carotid,and subclavian arteries, were stronger thanthose of the left ; but there was no appa-rent difference in the pulsations of the ra-dial aiteries.

As soon as the tumour made its appear-ance, the cough and dyspnœa, ceased to betroublesome, and his health was soon re-

established.. His chest sounded well uponpercussion, and the respiratory murmur

was distinctly heard all over it. No unna-tural pulsation could be detected, by theuse of the stethoscope, between the tumourand the heart. A loud and powerful pulsa-tion was heard over the tumour, unattendedwith any unusual sound.

’

In taking into consideration the situation.of the tumour,-its sudden appearance, aftera violent paroxysm of coughing, and itssoft pulsating character, together with thesymptoms above enumerated,—little doubtcould be entertained of its nature, and Iconcluded that the root of the carotid arterywas the seat of the disease.

Considering this a favourable case for theoperation lately revived, and so ably advo-cated by Alr. Wardrop, I was’induced toobtain the opinion of two eminent surgeonsin London respecting its propriety. Both,however, disapproving of the operation, itwas, therefore, determined, with the ap-probation of my friends, Mr. Bennet, and

Mr. Brown, of Derby, that a fair trial; should be made of Valsalva’s plan of treat-ing aneurisms., The nature of the disease was fully ex-plained to the patient, who, fortunately, wasa man of strong sense and most determinedl resolution, and, from his employment lead-, ing him to study the diseases of horses,

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there was no difficulty in making him com-prehend the dangerous tendency of the dis-ease. He therefore submitted, with per-fect confidence, to the proposed plan oftreatment ; and I cannot sufficiently admirethe fortitude and cheerfulness with whichhe bore the long privation which it was ne-cessary to enforce, and the implicit faithwhich he placed in all the remedies adoptedfor his relief.

April 3. He was accordingly ordered tobed, to he bled, to the extent of eight ounces,every third day ; his diet to consist of smallquantities of gruel, broth, and tea. Smalldoses of digitalis were likewise adminis-tered. This plan of treatment was conti.nued until the 13th of July. During the.first month, there appeared some little im-provement ; his pulse was frequently as lowas 47 in the minute, the tumour becameharder, its pulsation less forcible, and moreremote; from which it was supposed thatcoagula might be forming. The blood hi-therto had seemed perfectly healthy, and itwas noticed that, if the bleeding were de-layed beyond the usual time, the symptomswere aggravated.

In the beginning of May, a great altera-tion, for the worse, took place, which wassupposed to be owing to his taking a smallquantity of animal food. The blood, aftereach bleeding, became bu6ed ; pulse 80 inthe minute ; the tumour rapidly increasingin the course of a few days, and becomingvery painful upon pressure. Twenty leecheswere applied, without any relief. A few

days afterwards a diarrhoea supervened, theinflammatory state of the tumour abated,the pain ceased, and the swelling, in somedegree, sulaaided. After this attack, his

pulse was never less than SO in the minute,although the same plan of treatment wasrigidly adhered to.From this time until the 1st of July, the

tumour remained stationary ; but, from thelatter date, until the 20th, he gradually gotworse; the tumour increased, and nowreached as high as the cricoid cartilage, and,by its pressure upon the trachea and (pso-phagus, partially impeded respiration anddeglutition. His shirt-collar, which, priorto his illness, would button comfortably,could not now be made to meet by morethan three inches ; his countenance becamebleached; pulse more feeble ; and it wasevident that the lowering system had beencanted as far as it could with safety.Under these circumstances the operation

was recommended, as the only remainingchance. Its advantages and disadvantageswere fairly stated, and the chance of suc-cess, although small, made him anxious thatit should be performed. Dr. Bent, of Derby,saw the patient on the 17th, ’and concurred

in the propriety of the operation, as alasthope.On the morning of the 22nd of July, the

day proposed for the operation, the patientbecac o agitated, that the pulsation ofthe tumour of the heart, and the large arte.ries, especially the abominal aorta, was

perceptible to the eye. The operation wasperformed in the presence of Messrs. Ben.net and Brown, of Derby ; Mr. Ingle, ofAshby -de-la-Zouch ; and Mr. Walne, of

Chancery Lane, surgeons. In consequenceof the tumour extending so high up theneck, there was some difficulty in gettingdown to the sheath of the artery, which wasopened to the extent of half an inch. Theartery appeared healthy, and was easilysecured by a single ligature of strong silk,Immediately after tightening the ligature,the pulsation in the different branches ofthe external carotid artery ceased, except aslight fluttering in the extreme branches ofthe temporal. The pulsation of the tumourcontinued without diminution.

23 and 24. He went on well. The pulsa.tion in the tumour was stronger than it wasbefore the operation, and the pulsation ofthe right radial artery was observed to bemore forcible than that of the left.

25. He became feverish ; pulse 120, andfull ; the right lip of the wound swollenand painful. Six ounces of blood were takenaway from the arm, and some saline medi.cine administered. The blo d was muchbuffed.

26. Morning—Much better; pulse 9?,stronger in the right radial artery than inthe left ; pulsation in the tumour still veryforcible.

Evening.-The fever, and pain in the tn-mour, returned. He was again bled. Bloodstill buffed.

27. Better again this morning. He wastaken worse at nine o’clock in the evening.Pulse 100 ; delirous ; anxious countenance,and sickness. No diminution in the size ofthe tumour.

28. Much better, and continued so allday.

29. At seven A.M. he was taken suddenlyworse, and appeared to be dying ; his coun-tenance ghastly, and covered with perspiration ; tracheal rattle, and inability to swal-low. He appeared conscious, but could

only speak in a whisper ; pulsation in thetumour still forcible ; the pulse in the rightradial artery scarcely perceptible, whilst theleft pulsated as strongly as it did the pre.vious day. These symptoms were accom.panied with a profuse ptyalism. He re-mained in this state for several hours, at

the expiration of which time he raiiied.mfiby the evening (with the exception of thesalivation, which continued,) he appearedquite as well as on the preceding day.

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As he continued to improve from this ! :period, it will not be necessary to enter into .a daily report of the case ; 1 shall tlierefore i

content myself with noticing the most pro-minent symptoms which occurred. One ofthe most remarkable was the obliteration ofthe arteries of the right arm and forearm,which was first observed in the arteries ofthe forearm on the 2i)th of July, the eighthday after the operation, for until that daythe arteries of the right arm pulsated withgreater force than those of the left. The

process of obliteration was attended withsevere intermittent paroxysms of pain,chiefly felt in the course of the brachial andaxillary arteries. The brachial artery, afterits obliteration, was hard and painful to thetouch, and felt very like an innamed ab-sorbent vessel. The right arm wasted, andbecame partially paralysed, and continuedto diminish for three weeks, at the expira-tion of which time several arterial anasto-

mosing branches were observed ptalsatingon the back part of the arm. As tilesevessels enlarged, the limb improved-veryslowly, not having yet (Oct. 19) perfectlyacquired sensation, nor its muscles the

power of obeying volition.On the llth day after the operation, he

was attacked with intermitting paroxysmsof pain in the right side of the head andface, of the same character as the pain inthe right arm, though not so violent : this

pain ceased within a fortnight. The rightside of the head and face became emaciated,and any one looking at him would imme-

diately discover, that the right half of theface was much smaller than the left. Theblood having since found its way into the

temporal and facial arteries, the right sideof the face is now nearly as plump as the Ileft. ’

The ptyalism, winch began on the 29thof July, continued until the middle of Sep-tember, during which time he spat dailyabout a pint of sahva; a more generousdiet, and a small quantity ofaie, were thenallowed, and the salivation subsided.Three weeks after the operation lie was

able to sit up to his meals. The first timethat he got out of bed, he perceived thatthe whole of the right side was numbed, andweaker than the left. The pulsation in thetumour, which had litherto been more

powerful than it was before the artery wastied, now (Aug. 15) began to diminish ra-pidly, and by the 23d of August, the thirty-third day after the operation, had so muchsubsided, that it was doubtful whether itarose from the passage of blood into thetumour, or from the imputse given to it bythe subclavian artery beneath.

In five weeks after the operation, he wassufficiently recovered to be able to take

daity exercise in a gig, or on horse-back,

and from this time he has continued to im-prove in health, without interruption.

’1’he oblileration of the right bracliial ar-tery is now complete, and above the inser-tion of the latissimus dorsi the pulsation ofthe ax’dlary artery can be easily felt. The

pulse in the radial artery is scarcely per-ceptible in the right arm, increases daily,but is yet far from being of the size of theleft. Sensation and susceptibility of theinfluence of volition are more perfect on thewhole of the right side of the body, butstill that side is more feeble than the left.The tumour is hard and firm, and has dimi-nished about one-third since the operation.By pressing it from above downwards, afeeble, deep-seated pulsation is felt, but in:grasping the tumour and using lateral pres-sure no pulsation can be perceived.

On the 13th of October the wound was

nearly healed ; the ligature had not comeaway, and as it acted as a source ofirritationto the small wound, it was cut off level withthe skin.The most peculiar featur’ which this

interesting case presented were—1st, Theobliteration of the arteries of the right arm ;2nd, The profuse salivation ; 3d, The tlis-position to paralysis of the whole of theright side of the body.The two first symptoms commenced on

the 8th day after the operation ; and I thinkthere can be little doubt that the obliterationof the arteries of the arm was accomplishedby inflammation extending from the aneu-r!S!ua[ sac to the internal membrane of thesubclavian artery, and thence to the bra-cilial artery. Might not the active oblite-iation of such large arteries as those of thearm and fore-arm, be the cause of the un-pleasant train of symptoms which occurredon the 8th day after the operation ? Thesalivation appeared to be connected withthe state of the digestive apparatus ; for, assoon as ale, and a generous diet, were

allowed, it gradually subsided. I am at aloss to assign the cause of the numbnessand debilitv of the whole of the right sideof the body, (which were only observedwhen he first left his bed), unless theyoriginated in a greater quantity of bloodcirculating in the left hemisphere of thebrain than in the right, which undoubtedlywould be the case after the application of aligature to the common carotid. What tendsto confirm this opinion is, that now, 13weeks after the operation, the balance ofcirculation in the brain being re-established,the numbness and debility of the right sideof the body have nearly disappearc d.

In conclusion, i t is worthy of notice, that,since the operation, lie has become moreirritable in temper, and his memory is

evidently weaker.So far as this case has yet proceeded, it

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amply justifies the operation; and the manprobably owes his life to Mr. Wardrop’sfortunate suggestion and example. Shouldany untoward circumstance occur, leadingto any other conclusion, it shall be commu-nicated. ’

It is now five weeks since he resumed hisusual avocations, and he regularly attendsthe markets and fairs of Derby, a distanceof seven miles.

Belper, Oct. 22, 1828.

ERGOT OF RYE.

F. FROGGATT, Surgeon.

To the Editor of THE LANCET.

SIR,—Having read in your weekly publi-cation several cases of lingering parturi-tion, as well as of abortion, successfullytreated with the ergot of rye, I beg totransmit to you the following case, if youthink it worthy a place in your valuable Jour-nal. Mrs. G., retat. 26, who has had sevenchildren, (and has generally trifling pains,with a sanious discharge, a week before

delivery) sent for me to attend her, Sept. 26,in consequence of a violent flooding shehad had upon her for three days, (beingin her sixth month of pregnancy with the

eighth child.) From all the circumstances ofthe case, considering the debility my pa-tient was labouring under, I thought it ad-visable to deliver her as soon as possible. I

prepared an infusion of the ergot, (iij. to iv.of water), and administered half, and afterwaiting ten minutes I gave the remainder,without any effect whatever ; I sent out foriv. from a friend and infused it in vj. ofwater, administering one-third every quarterof an hour, without producing the leastaction about the uterus. As I was anxious toknow how far it was possible to push theergot, I sent to another friend, and obtained:5ss. more, the time occupied by sending, andmaking it, was not more than a quarter ofan hour. I then gave her half of it, and, inten minutes, the other half, which, like therest, had no more effect upon the uterusthan if the same quantity of water hadbeen given. After the administration ofthe third dose the haemorrhage entirelyceased; the pulse, which before was veryfeeble, and indistinctly felt, gradually roseuntil it had attained its original standard.From the favourable symptoms above-men-tioned I did not feel inclined to adopt othermeans to deliver her, she has now everypossible chance of going the full time of

utero-gestation. I have since given her j ofthe ergot occasionally, by way of experi-ment, as she complained, after she had thefirst quantity, of the desire she had to void

her urine; I found, after every dose I gaveher, that it produced the same sort of stran.gury ; but I could not ascertain that itaffected the uterus in any way whatever.

Yours obediently,F. FROGGATT, Surgeon.

Westminster, Oct. T, 1828.

THE APOTHECARIES’ COMPANY.

To the Editor of THE LANCET.

SIR,—The universal circulation of yourpublication renders it imperative on you tohear both sides of every question broughtbefore the tribunal of public opinion. I ap.peal to your candour, justice, and interest,on behalf of the Apothecaries’ Company,against the heavy charges brought againstthat body by you, and some of your Corre-spondents. You say, (and I take yourassertion, cum grano labis, for truth,) thatthe general body of Practitioners possessintelligence and skill equal to monopolisingHospital Surgeons and Physicians; and doesit not occur to you, that nine-tenths of themare apothecaries as well as sturgeons anddoes not the contempt you show for vendersof drugs insult the understandings of mostof your readers *! You must be well awarethat the apothecary is the physician of thepoor and middling, the most numerous andmost useful class of his Majesty’s subjects;and the Apothecaries’ Company, by requir.ing higher qualifications in their licentiates,confer a great benefit equally on the professionand on the public.The Apothecaries’ Act was an expostfacto

law to me, but I cheerfully complied withits enactments, because I saw I should gainin knowledge and respectability far morethan I lost in additional expense of time and

money. When every class in society is ad-vancing, would you have the apothecary,the productive labourer’s physician, alone

stand still, or retrograde *! And what know-

ledge do the Apothecaries’ Examiners reo

quire that is not useful, not to say reces-sary, to the medical practitioner? Botanyis not wanted in London, it is true, and per-haps less latin than they require might doto decipher M.D.’s scrawls ; but is it no.

thing to raise the respectability of the pro-fession’! Is it not disgraceful to every mem-ber of a supposed learned profession, notto possess knowledge enough of Latin to readthe quotations that frequently occur in scien-tific books, and even newspapers’! So far

:’ from asking too much, the Exami)iers do notask enough and, if they do their duty faith.

fully to the public and to the profession,’ they will, after sufficient notice, require( Greek and French, at least, to form part of