89

Robert Henry French, Esq... 25 0 0 ’

Beresford Worthington, Esq. 10 0 0Sir A. B. King, Bart......... 20 0 0Richard Milliken, Esq....... 17 0 0Josia Franklin, Esq..... 5 0 0Rev. William Higgins ...... 21 0 0Doctor Neason Adams ...... 25 0 0L. White, Esq. per -Messi-s. Ball

and Co.................. 20 0 0Lord Cloncurry, per Sir R.Shaw, Bart. and Co....... 50 0 0

Alexander Jackson, Esq M.D. 50 0 0Robert Pentland, Esq. Drog-heda Infirmary ......... 10 0 0

J. W, Cusack, Esq, M. D. .... 50 0 0E. M’Dowell, Esq. M.D. .... 6U 0 0H. W. Rowan, Esq. ..... 10 0 0Messrs. John Huttun and Sons 10 0 0Richard Cane, Esq......... 20 0 0

Major Sirr ................ 5 0 0William Edington,Esq..... 15 0 0Daniel Moore, Esq. Anne-str. 20 0 0

: S. G. Richards, Esq......... 20 0 0The Lord Chief Baron ...... 20 0 0

’ Simeon Boileaa, Esq....... 50 0 0Messrs. Hodges and M’Arthnr 21 0 0From M. M. ..... 20 0 0John Dunne, Esq........... 20 0 0Doctor Stack .............. 10 0 0James M’Cauley, Esq. M.D. 5 0 0Messrs. Craven and Nicholls 25 0 0Doctor Evory .............. 100 0 0Doctor Croker.............. 5 0 0Robert Hall, Esq........... 20 0 0A. B. Crofton, Esq........... 50 0 0ltiiss Crofton .............. 30 0 0

George Crofton, Esq. 0..0.. 20 0 0nontenant - Colonel Dorville,

Grenadier Guards ........ 5 0 0John Bolton Hawkins, Esq... 5 0 0

Major Leslie..... 20 0 0Colonel Hill................ 10 0 0Edward Johnston, Eq....... 5 0 0Edwin Johnston, Esq....... 5 0 0l.ieutenani-Colonel De rlrcy 5 0 0Lord Bishop of Raphoe.....0 5 0 0Sir George Rich ............ 5 0 0Sir Stewart Bruce ..... 5 0 0Robert Wilson, Esq. Mount-joy-square. 0 0 0............ 20 0 0

Edward Synge Cooper, Escl. 100 0 0R. W. Cooper, Esq......... 21 0 0Rev. S. R. Worttington ..... 10 0 0Messrs. Gibbons and Williams 25 0 0John George, Esq......... 20 0 0Dr. Hume (per Messrs. Gos- -

lings and Sharpe) ........ 50 0 0

Subscriptions are received by Sir Wm.Curtis, Bart. and Co. ; Messrs. Goslingsand Sharpe; Messrs. Pnget and Bain.bridges; Messrs. Coutts and Co.; Messrs.Herries ; Sir Thomas Farquhar and Co. ;and Messrs. Hammersleys.

HOSPITAL REPORTS.

GUY’S HOSPITAL.

Compound Fracture of the Cranium., Thomas Brooks, aged 13, a robustboy, was bronght into Accident Ward onthe 3d of March, with compound fractureof the os frontis, and placed under thecare of Mr. Morgan. He states that onthe day of his admission, as he was in theact of feeding a horse, the animal struckhim on the forehead; he was stunnedby the blow, but quickly recovered, andwhen brought to the Hospital, iinme-

diately afterwards, was perfectly sensible.The wound was situated about a finger’sbt-eadfhabove the right superciliary ridge,being an inch in length and half an inchin breadth; two small pieces of bone,loose portion, of the external and inter-nal tables of the skull, were removedwith a pair of dressing forceps, exposingthe diu’amater, which pulsated strongly ;the edges were then brought into contactby the adhesive plaster.

4. Pulse 85, strong; tongue coveredwith t whitish fur ; pupils dilated ; painover the wound ; he is perfectly sensible,and sleeps well. V. S. ad xvj. low diet.’ .5. Pulse 90, and jerking ; pain andpulsation at the seat of the wound; pupilsdilated, but contract to the influenceof light; thirst, dry tongue, hot skin,bowels open. V. S. ad x. and a mixtureof magnesia and salts to be given everyfour hours.6 and 7. Stept well ; no pain in the

head ; pupils dilated ; pulse 100, com-pressible ; tongue less furred; bowelsopeit ; appetite good. V. S. ad x.

8. Putsation over the wound still con-tinnes; pulse 104, and soft; bowels open;free from pain; pnpils Jess dilated, andmore obedient to the light ; sleeps well.

10. Pulse 90, and regular; pupils na-tural; in every other respect doing well;the wound has not completely united bythe first intention, but looks healthy.From this date to the 25th, when the

patient went ont, he continued well, andleft the Hospital with the wound nearlyclosed.

Fatal Case of Strangulated ScrotalHernia.

Joseph Pring, aged 82, of a very spat@,habit, was brought into the accidentward on the 22d of March, labouring

9)

under strangulated scrotal hernia of theleft side. It appeared that for a conside-rable time he had been the subject of asman tumour, situated immediately belowthe exteinal abdominal ring, and that onthe 17th it suddenly became enlarged anddescended towards the scrotum. On the

following day he felt sliglit pain and un-easiness at the part, and vomitedseveral times. From that time to the pe-riod of his admission into the Hospital hewas frequently sick and his bowels re-

mained constipated.On his arrival at the Hospital about

noon, on the 22d, he labonred under thefollowing symptoms: the bowels had notbeen open since the 17th, a short timebefore the hernia descended. Pulse 80,and small ; respiration hurried ; counte-nance anxious; and there was great pros-tration of strength ; he had not vomitedsince the preceding evening. The hernia

appeared to have descended about halfway down the scrotum, it was of the sizeof a small fist, not very teuse, but exceed.ingly painful on pressure, the integumentscovering it were slightly discoloured, therewas no particular tenderness of the ab-domen.Mr. Morgan employed the taxis for a

short time, he then directed the warmbath, and again attempted the reductionof the hernia, but failed in his endeavours.A proposal was now made to the patientto undergo an operation, to which he

Ireadily consented.

Operation.About one o’clock, the patient was

brought into the operating theatre, andplaced upon a table of convenient height,the pubes was then shaved, and the sur-geon proceeded to operate. Placinghimself on the left side of the patient, hebegan his incision from the bottom of thetumour, carrying it directly upwards its,whole length ; by this incision the inte-guments and spermatic fascia were

divided, and the fibres of the cremasterexposed. Having cautiously divided thiscovering, the hernial sac was !aid bare,it was of a bluish colour, and was pointedout to the students as a good specimen ofthe appearances the hernial sac in generalpresents. The operator now pinched upthe sac between his finger and thumb, andmade a small opening into it with a scal-pel, through which a director was intro-duced and the division completed with aDistonry. The contents of the sac werenow brought into view consisting of aknuckle of intestine, covered by a portionof omentum, both were deeply congested,but there was no appearance of gangrene;

slight adhesions had formed between thesac and its contents, but they were readilytorn asunder with the finger. The stric.ttire was at a short distance above theexternal abdominal ring, and was dividedin the usual manner; the intestine was

easily returned, a portion of the omentumwas cut off, and the remainder left as a

plug to the month of the sac.At the conclusion ot’ the operation the

poor man seemed much exhausted; hispulse was small, his countenance pallid,and his extremities cold; he was put tobed, and warmth applied to his feet.-About two o’clock he was visited by Mr.Morgan ; he then expressed himself freefrom pain, but the vital powers continueddepressed. Mr. Morgan directed a table-spoonful of brandy to be given imme-diately, in a dose of the julep of ammo-nia, and to be repeated every threehours ; a common purgative enema to beadministered half an hour afterwards.March 23. The bowels have been freely

opened; he speaks this morning in a lowdesponding tone, and the countenance isexpressive of much anxiety. Pulse 110,small, weak, and irregular; the extremi-ties are cold, and he complains of someuneasiness about the abdomen, but no

pain upon pressure ; he has slight painsshooting across the hypogastric region,and was very restless during the night.Leeches to be applied to the abdomen,and afterwards a large blister.On visiting him in the evening we found

him labouring under that morbid restless-less which is the harbinger of death; hetossed the bed-clothes about, and was nn-able to find ease in any position; thecountenance pourtrayed great anxiety,

and the pulse was fluttering. We learnthat he expired about midnight.

Inspectio Cadaveras.

On opening the abdomen the portionof intestine that had been strangulatedwas found to be restored to its naturalsituation ; it was nearly of the same darkcolour as when exposed at the operation;with this exception, the whole tract ofthe alimentary canal was quite healthy,manifesting no signs of inflammation hav-ing prevailed. The external and internalabdominal rings were, as is usual in oldhernia, nearly in contact, and thus byobliterating the inguinal canal, giving tothe tumour the appearance of a directhernia, whereas it was in fact of the ob-lique kind. The sac extended into thescrotum to within an inch of the testicle,and it was firmly connected to the sur-

rounding parts.

91

Case of Traumatie Tetanus szcccessfullptreated.

Thos. Mumford, ætat. 2fi, of fair com-plexion and spare habit, was admittedinto the Hospital on the 14t!) of February,under the care of Mr. Morgan, on ac-count of severe injury to the right hand.The patient is a spinner and weaver ofblankets, and whilst engaged in someprocess connected with this employment,by some mishap his right hand was caughtin what is technically termed the " card-ing machine." All the angers were mnchlacerated, but more particularly the toreand middle fingers, of which the tendonswere exposed. The wounds were dressedin the nsaat manner with adhesive plas-ter ; from their nature it may well be

supposed that union by the first intentiondid not take place, and suppuration con-sequently ensued. The parts, however,were going on favourably, when, on the8th of March, (a period of three week,from the receipt of the injury,) symptomsof an alarming nature presented them-selves. He had pain in the back of theneck with stiffness, and the jaws couldonly be separated to the extent of abouthalf an inch ; he had also considerabledifficulty in deglutition, with occasionalspasms; pulse, 105. He had no pain inthe wounds, nor was there any change intheir appearance ; they were suppuratingkindly under the application of poultices.It appeared upon further inquiry that thesymptoms had come on gradually ; hehad felt (to use his own expression) astiffness and soreness about the muscies,on the back of the neck, loins, and shoul-ders, for five days previous to the date ofthis report; he attributed these symp-toms to his having caught cold, and there-fore it was not until the jaws had becomenearly closed that the attention of thesurgeon was directed to the symptoms.March 8. Mr. Morgan ordered a to-

bacco enema to be administered imme-diately ; it was prepared by infnsing halfa drachm of tobacco, for ten minutes, ina pint of boiling water; it produced noother effect than a slight dimness of sight.At noon Mr. M. directed one drachm oftobacco to be infused in a pint of water,this infusion to be administered directly,and two hours afterwards the followinginjection :-.

Oil of turpentine, one ounce and a half;Aftteilag-e of gum arabic, four ounces;Warm water, ten ounces.

The tobacco and turpentine clysters toM given every two hours alternately. Inthe evening the pulse was of the samequickness as in the morning, but small .:

there was profuse perspiration, and theextremities felt cold.

9. We find the patient this morningwith a pallid countenance and great pros-tration of’ strength; the pulse 59, smalland irregular; be is very sick and hasbeen so throughout the night, vomitinga yellowish fluid. The pupils are con-

tracted, the jaws appear to be rathermore dosed, and there is a considerabledegree of stupor; profuse perspirationcovers the body.The last tobacco enema was adminis-

tered at eleven o’clock last night, sincewhich he has refused to have any more

injections. The following draught to betaken every three hours:-

Laudanunt, one drachm;Compound spirit of sulphuric œther,half a drachm ;

Camphor mixture, one ounre.

10. He can open his jaws to the ex-tent of an inch; pulse 98 ; the abdominalmuscles somewhat rigid; the pupils re-

main contracted and he appears drowsy;the tongue is moist and furred ; the bowelsconstipated. He complains of pain in theback, but can move his head in any direc-tion ; there is still difficulty of deglutition.The wound is filled with healthy granu-Iations.

11. There is increased rigidity of theabdominal muscles ; pulse 100, small ;the contraction of the jaws much thesame. Continue the mixture, and in theevening let a purgative enema be admi-nistered.

12. The rigidity of the abdominal mus.cles and closure of.the jaws are much asyesterday. Pulse 105; the bowels freelyopen. He complains of pain in the backand neck ; the muscles at these partshave a natural feel. The wound has a

healthy appearance, although the dis-

charge is somewhat offensive; it is dress-ed with opium ointment, prepared- in thefollowing manner, which is spread onliut, and over this linseed meal poullicesare applied :-Powder of opium, three drachms;Spermaceti cerate, six drachms. Mix.

March 13. The jaws admit of muchmore separation than yesterday, and theabdominal muscles are less rigid. Pulsemuch reduced in frequency, being only76. Continue the mixture.

15. We find him this morning sittingup in bed, his countenance is cheertul,and he is upon the whole much improved,the jaws wiII admit of his thumb passinginto his mouth. The bowels are consti.pated, on which account a purgative ene.ma was prescribed.

92

16. The flattering state of the patientyesterday led us to believe the case wasgoing on favourably; to-day, however, wefind the abdominal muscles have againbecome tense, and the stiffness about theneck and back is also felt.

Calomel, five grains;Opium, one grain;

to be taken immediately.The mixture to be regularly given, and

in the evening a colocynth enema to beadministered.

17. The bad symptoms of yesterdayhave subsided.

19. He can now open the jaws to theextent of two inches, and swallows withease. Continue the mixture with theoccasional exhibition of an aperientenema.

21. In attempting to walk to-day, hefell down suddenly, without, however,suffering any injury. He feels a slightstiffness about the jaws, but they can beseparated nearly to their natural extent.

28. Going on favourably ; he continuesto take the mixture, and occasionally adose of aperient medicine. The woundon the fore-finger is healing fast.

29. No unfavonrable symptom. The

quantity of laudanum in the draught re-duced to-day from one drachm to forty-tive drops, which dose he was directed totake every four hours.

It may be worthy of remark here, thatthe opiate draught, containing one drachmof laudanum, was prescrihed on the 9th ofMarch, and that the patient continued totake this quantity of laudanum everythree honrs until the 29th of March, beinga period uf 21 days.

April 4. Still free from any tetanic

symptom. The wound on the tore-fingerhealing fast. The laudanum (we knownot for what reason) is still administered.

8. Although it is nearly a fortnightsince any symptom of tetanus was mani-fest, the laudanum is continued. Is thisto prevent a relapse ?

Fatal ease of Punctured Wound.

George Riches, aetat. 48, a robust la-

bonring man, whose habits of life havebeen rather of an intemperate nature, wasadmitted into the accident ward, on the27th of March. He stated that whilstremoving a box, a rusty nail penetratedthe tore-part of his wrist, this happeneda week before his admission. On thefourth day after the accident, he foundhis hand much inflamed, attended with

great pain, and on the following day smalldark-coloured vesicles presented them-

selves around the puncture. At thistime also the arm became much swollen,symptoms of high constitutional irritationcame on, he had thirst, restlessness, andgreat pain.On his admission the hand and arm

(extending as high as the shoulder) wereimmensely swollen, very tender uponpressure, and somewhat cedematous.There was not much redness, except onthe anterior part of the fore-arm, lowdown. There were bluish-coloured vesi-fies around the puncture, and yellowishones on different parts of the fore.arm : there was no distinct inflammationof the absorbents to be traced, nor glan-dular enlargement in the axilla. He was

walking about the ward, when we visitedhim, in great agony.

An extensive incision was made in frontof the wrist, and another on the back ofthe hand, the latter exposed the cellularmembrane, apparently gorged with an

effusion of lymph, it had a gelatinous ap-pearance ; but very little fluid escapedfrom the incisions. Poultices were ap-plied over the arm and hand.

28. On visiting the poor man at twop. m. to-day, we find him labouring underthe most alarming symptoms. There is

great difficulty of breathing, with a

marked anxiety in the countenance, thelips and cheeks of a livid hue, the tonguecovered with a brownish fur, but moist,and the extremities cold. The foreheadis bedewed with drops of sweat, a dis-

tressing sense of suffocation in the re-

cumbent posture, and the pulse at thewrist is scarcely perceptible ; during thenight he vomited and was very restless.He died about half an hour after our

visit. No examination of the body wasmade.

ST. THOMAS’S HOSPITAL.

Fatal Injury to tke Head.R. F. set. 64, a stout man, of short sta-

ture, was admitted into the Hospital onthe 4th of April, under the care of Mr.Travers, on account of injury to the head.The accident occurred under the follow-

ing circumstances :-His arm became en.tangled in some machinery, and beingthus drawn in, a wheel, which was rapidlypassing round, repeated iy struck his head.It was with some difficulty that he wasre-leased from this perilous situation, for aman who was standing by was so panic-struck, that he lost all presence of mind,and neglected to employ those meanswhich might have extricated the poorman. Eventually, however, he was re-