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HOSPITAL REPORTS.

GUY’S HOSPITAL.

Case of superficial Fungus of the Testicle.C. W., xtat. 46, a healthy looking man,

was admitted into Cornelius’ Ward,nnderthe care of Mr. B. Cooper, with diseaseof the right testicle. He says, that abontnine months since, he received severe in-jnry to the testicles, in consequence of ahorse falling upon him. Both testiclesbecame much swollen, and, according tohis account, the parts must have gone onto suppuration. He states there was an

opening opposite to the lower part of eachtesticle, from which matter issned. Inthe space of three months, the parts werewell, and he resumed his usual employ-ment.About the time of last Christmas, the

right testicle began to enlarge, was verypainful, and shortly after he perceived adark spot on the scrotum, about the sizeof a sixpence, which gave way, and a

fnngns appeared at the part; this has

gone on gradually increasing, but attend-ed with little pain, and no constitutionaldisturbance. There is now a firm andalmost insensible fungus, of the size of alarge walnnt, projecting through the in-

teguments of the scrotum on the rightside, about midway. On examining thepart, it is clearly to be felt that this fun-gons growth arises from the testicle itself,and that the greater part of this gland isinvolved in the disease ; the surronndinginteguments are much thickened and in-dnrated ; the chord is not at all enlarged.Mr. Cooper, on visiting this case, re.

marked, that it was simple fangonsgrowth following an abscess, that it wasentirely free from malignancy, and mightbe destroyed by escharotic applications.Pieces of liut made wet with the arseni-cal solution, to be applied over the fun-gus.Feb. 10. The whole surface of the

fungus is covered with a hard black crust.The arsenical solution has been appliedthree times; its last application (a fewdays since) occasioned considerable pain,and also nausea; the dressings were in

consequence removed, and poultices ap-plied.

Sir A. Cooper saw the patient to-day,and oti mentioning the preceding circum-stance to him, he remarked that he hadseen a case in which fatal consequencesensued ftom the local application ofFow-ler’s solution. He recommended the ex-

crescence to be removed by means of aligature passed round its base. Mr. B.Cooper, however, preferred removingthe tumour on a level with the scrotum,by means of the knife, paring the indu-rated edges, and bringing them togetherby adhesive plaster ; this was accom-plished on Thursday last.On examining the tumour, it was found

to consist of the glandular substance ofthe testicle ; the tubuli seminiferi werevery apparent, and readily drawn outfrom the back part of the ttamour ; thetunica albuginea was very much thick.ened.

Case of Retention of Urine from Stricturein the Urethra.

C. D., a middle-aged man of spare ha-bit, was adntttted into Naaman’s Wardon Tuesday, Feb. 7th, as a patient of Mr.Key, labouring under retention of urine.

It appears that he has had permanentstricture upwards of fifteen years withconsiderable enlargement of the prostategland,’and has been several times in theHospital, on that account. He says that

during the last four years he has been in-capable of retaining his urine, and it haspassed away guttatim.On the day previous to his admission,

there was a total stoppage of urine, andhe began to experience much pain ; as hewas not relieved, he came to the Hospitalon the following day. When admitted hehad considerable tension and tendernessin the pubic region, great pain and un-easiness about the neck of the bladder.Pulse small and quick ; tongue coveredwith a white fur.Mr. Key directed him to be put in a

warm bath, twelve leeches to be appliedto the pubic region, and a dose of castoroil to be given immediately; these ntea-sures were complied with. In the after-noon Mr. Key attempted for a considera-ble time to introduce a silver catheter,but without snccess ; the instrument

passed down to a very firm stricture inthe membranous portion of the urethraand there remained. Being thus baffled,Mr. Key wished the instrument to remainfor some time in the urethra, anticipatingthat the stricture would by that meansyield. The patient, however, removedthe catheter previous to Mr. Key’s visitin the evening, which was about 9 o’clock ;he did not at this time deem the symp-torr.s sufficiently urgent to warrant an

operation for emptying the bladder.Feb. 8. The scrotum is much swollen,

and is of a dark red colour ; there is alsomuch distension of the integuments in theperinæum; the man is tolerably free from

750

pain ; a small quantity of urine has dribbled away. From the appearance of thescrotum and perinæum, Mr. Key was ledto infer that extravasation of urinehad taken place, and therefore immedi-ately proposed an operation to relieve thedistended bladder, as it had been foundimpracticable to pass a catheter.

Operation.Having placed the patient in the po-

sition for the operation of lithotomy, andpassed a catheter down to the stricture,Mr. Key made an oblique incision, up-wards of an inch in length, on the leftside of the raphe. The scalpel strikingon the point of the catheter, this servedas a guide in the operation ; the incisionwas carried on through the membranousportion of the urethra, and by drawingthe knife backward and forward, hedivided a very firm stricture, extendingfrom the posterior part of the bulbthroughout the membraneous portion ofthe nrethra, to the face of the prostate.Mr. Key now passed a female catheterthrough the wound towards the bladder ;he found some obstruction to its entrance,about the neck of the bladder,* but inthe course of a few minutes succeededin introducing it; when about two pintsof urine were drawn off, and the patientexpressed himself much relieved. Hewas put to bed, and warm fomentationsdirected to be applied over the abdomen.

9th. Has passed a good night, and isfree from pain ; the scrotum and peri-naeum are much less swoiien, thecatheter is retained in its situation.

iltli. The report of to-day is, that thepatient is going on well,the swellingof the parts greatly reduced.

16th. Mr. Key attempted to pass a flexi-ble catheter to-day, but did not succeed ;his object, if he can pass the catheter,is to retain itin the bladder, and heal thewound in perinaeo over the instrument.

Extraordinary Case of Hydrophobia!A. Davison, a waterman, setat. 23, of

dark complexion and spare habit, wasbrought to Guy’s Hospital in a liackney

The obstruction Mr. Key imputes tothe sphincter vesicæ, which he says liehas seen in several instances, forming"a kind of valve"!The enlarged state

of the prostate gland probably affordsa more satisfactory explanation of the

difficulty in passing the instrument thana sphincter valve,

coach, on Thursday night, (Feb. 9,) aboutten o’clock. The friends who accom-

panied him stated, that he had been un.well since the preceding Monday ; onthat day he first complained of pain inthe head and began to talk incoherently,they further stated that he became veryrestless and unmanageable, and that liehad not taken any food since his attack.He has been very irregular and dissipatedin his habits.

It appears that he was bitten by a dogabout ten weeks betore admission, whilstin the act of washing the animal; thescars were very evident on the back partof the wrist, near to the lower end ofthe ulna.

There was no proof adduced of the dogbeing in a rabid state ; it was, however,shortly after destroyed. It is right to

observe, that the poor man’s friends werefully impressed with an idea, that he la-boured under hydrophobia, and this im-pression was also deeply made on themind of the patient, as we shall presentlyfind.With regard to the symptoms when

admitted, as we were not present, we canonly rely on the report of his surgeonand immediate attendants, all of whom

expressly state that he had symptoms ofhydrophobia. On opening the coach-door for the purpose ot’ lifting him out,he said that lie conld not bear the air toblow upon him, he struggled and atfirst refused to be taken out. Eventn-ally lie was removed and placed inbed, when he said to the pnpils stand-ing around, that he had been bitten by adog, and that he would bite those aroundhun. Pulse 110, great wildness of ex-pression, with fearful agitation.At eleven o’clock, he was seen by Mr.

Morgan, Mr. Callaway and Dr. Back,who afterwards retired in consultation ;the result of their deliberation was toabstract blood from the arm and to injectthe veins with a solution ofopinm. He wasremoved to the Operating Theatre, andbled to the amount of 18 oz.; but on at-

tempting to inject the vein, he became sorestless and unruly that it was found im.practicable.He passed a sleepless night, he talked

much and incoherently, frequently ex-claiming "they are going to kill me,""the bed is sinking under me," &c.On the following morning we visited

the patient ; he was then in a state offurious delii-iiiiii, and it was necessary toemploy the strait-waistcoat in order torestrain him ftom violence ; his whole ap-pearance was that of a maniac, he hada glistening eye, with a wild suspicion

751

look; he was exceedingly voluble, givingutterance to an infinite number of ideasin rapid succession. Pulse 120, tonguemoist and covered with a white fur; therewas a secretion of viscid saliva, which hespat out with difficulty.On offering him some water in a tin-

vessel, he took it and conveyed it to his

month, but immediately withdrew it, withthe wild hurried motion of a maniac, with-out any convnlsion or spasm being exci-ted. If blown upon by any person, hewas immediately sensible to the currentof air, and exclaimed in an agitated man-ner" You know I cannot bear that."*It was confidently and unhesitatingly pro- inounced by the medical gentlemen whosaw him on the niglit of admission to be a" well-marked case of hydrophobia," and itwas under that impression that an attemptwas made to inject the veins with a solu-tion of opium. The "well-marked symp-toms" of hydrophobia (strange to say)having disappeared, some of the " learneddoctors" were disposed to " back out;"stoutly affirming, however, that the dis-ease was hydrophobia at the time of thepoor man’s admission. (Credat Judœus.)Uthers strenuously maintained that thepatient was still hydrophobic. Dr. Bright,in his native simplicity (of heart), kindlyinformed his pupils this morning at lec-tnre, that there was a case of hydropho-bia in the hospital, which he thoughtworthy of their attention, remarking thatit would probably terminate fatally in

eight hours. About noon, Sir AstleyCooper saw the patient; he unequivocallydeclared it was not a case of hydro-phobia ; ’’the worthy Baronet" was a

little disposed to qtiiz. Dr. Wright, whois the resident apothecary at BethlemHospital, gave his opinion that it was’not mania.

*It is not at all surprising that in thishighly excited state of the nervous sys-tem, he should become exceedingly sus-

ceptible, and more especialty as he wasexasperated from the blowings and sprirck-lings which each pupil thought proper tobestow. Such treatment really was suf-ficient to make any man mad.

t We do not profess to put our judg-ment in competition with "mad-doctors"with regard to the nice distinctions andminute sliades of difference in " mindsdiseased ;" but if there be any precisemeaning attached to the word man’a,we maintain that the patient was mania-cal. Setting aside, however, the verbalobjection, we assert that the patient la-boured under mania, in that sense inwhich it is detmed by the best authors,

) On visiting the patient in the evening,we found him much the same as describedin this morning’s report, he was less -

furious in his vociferations, he had notslept during the day, and the pulse wasvery rapid. He drank whilst we werepresent more than a quarter of a pint ofwater, but certainly with considerabledifficulty, raising himself up from the bed,and begging to be supported. There didtfot appear to be any spasm about thethroat, so as to occasion difficulty of de-glutitiou; nor that distressing sense ofsuffocation which is so readily excited inhydrophobia by an attempt to drink.A consultation was held this evening

on the case, at which Dr. Back, Dr.Bright, Mr. Key, Mr. Morgan and Mr.Cal-laway were present. It was really amusingto hear the various conjectures of the° collective wisdom," and but that weare taught " to reverence our pastors andmasters" we would relate their subtle

speculations.The following plan was pursued through-

out the night :

B At ten o’clock, an enema was adminis-tered, consisting of half an ounce of

æther in gruel ; at twelve o’clock, an

ounce of sether and half an ounce of lau-danam were injected,.and about 5 A.M.a similar quantity of aether and laudanumwas injected. He slept one hour afterthe second injection,February 11. Pulse very rapid, 130 ;

pupil of each eye dilated ; he is less vehe-ment, but still talks much and very inco-herently. When requested to drink anyfluid, he does it with the apparent diffi-culty of yesterday. Two pills of colocynthand calomel were administered to him atnoon, which he swallowed.

12th. He parsed a sleepless night.Pulse very rapid and becoming feeble, thecountenance has a livid appearance, s-en.-sorium remains much affected ; he occa-sionally takes a little drink. A colocynthenema was administered last night. Welearn that the poor man died about half

past 10 o’clock this evening, being theseventh day from the attack.

Post-mortem Examination.

Head.The membranes of the brainwere healthy ; on slicing through the sub-stance of this organ, it was thought tohave more bloody points than nsnal.There were two slight spots of ecchy-mosis on the pia mater, opposite to themiddte lobe of the cerebrum ; no effusionin the lateral ventricles. Mr. Key thoughtt7te optic-thalami had it slight roseate hue!06 the spinat marrow, opposite to the

jnnction of the dorsal and lumbar vertebræ,there was ecchymosis beneath the melu,

752

branes, to about an inch in extent, and atthis part there was a distinct softening ofthe substance of the spinal marrow. The

pharynx and oesophagus, the larynx andtrachea, with the contents of the thoraxand abdomen, were afterwards examined,and found to be in a healthy state.

ST. THOMAS’S HOSPITAL.

Operations.On Monday, Feb. 13, Mr. Tyrrell re

moved a limb below the knee, in conse

quence of gangrene of the foot, occasioned by exposnre to cold. The poor man iabout 23 years of age ; he came into tluHospital under Mr. Tyrrell’s care, oi

22d of January, with both feet in a gangrenous state, having been exposed t(wet and cold, and at the same time almosdestitute of food. The parts had proceeded so far to destruction, that it was impossible to recover them, a line of separation having already formed between the dead and living parts. The

process which nature sets up in thesecases to rid herself of a useless memberwent on until considerable demand wa’made on the constitutional powers fromthe sttppuration, and Mr. Tyrrell deemetit expedient to remove the limb. It wa’shown to the pupils at clinical lecture orFriday last, when Mr. Tyrrell took at

opportunity of pointing out the change’that the parts had undergone in the line oseparation, which was immediately abovethe malleoli. There appeared to be a

condensation of the parts from the eifu-sion of adhesive matter; the integumentshad become glued to the fascia, and themuscular fibre was completely altered inits texture and appearance. The most

interesting circumstance, however, to beobserved, was the closure of the anteriortibial artery by means of coagulatedblood ; the coagulum was of about au inchin extent; both above and below this thecanal of the artery was pervious. Therewas also a clot in each vena comes, butit appeared to be confined to the deadpart and not continued upwards into theliving, like nnto the artery. The nerves

had undergone but little change ; the pos-terior tibial artery was closed up with

coagulated blood, and also its accompa-nying veins.The separation between the dead and

living parts of the other limb is going oil,and Atr. Tyrrell remarked, that in thecourse of a few days he should amputatethe limb.

On Friday, Feb. 17, Mr. Tyrrell am.putated below the knee in a case of dis.eased ancle joint.The patient is about eighteen years of

age, and has been in the hospital underthe care of Mr. Tyrrell upwards of fivemonths. The disease in the ancle wasof ten years’ standing, and from repeatedattacks of synovial inflammation, the partshad undergone such changes, that the pa.tient was prevented from using the limb;there were numerous sinuous openingscommunicating with the joint. The gene-ral health was not much deranged, but inconsequence of the useless state of thelimb, and the long continuance of thedisease, Mr. Tyrrell thought proper to

propose amputation. The opinion ofMr.Travers and Mr. Green were requestedas to the expediency of the operation;both of these gentlemen concnrred inopinion with Mr. Tyrrell concerning thechanges which the parts must have un-dergone, and the little hope of renderingthe limb useful; but they did not consi.der it right to amputate until the consti-tution should begin to suffer.Mr. Tyrrell, however, exercised his

own judgment, and removed the limb.We have thought it right to mention thisdifference of’ opinion amongst such emi.nent men, because it is an importantpractical point.Mr. Tyrrell, in offering some clinical

remarks on this case, observed, that itwas a rnle of practice with him to am-

putate in cases where the disease was oflong standing, still going on, and the linibalready useless, without waiting for thesupervention of constitutional derange.ment.The examination of the parts showed

the disease to be progressing at some

points, whilst the reparative process wasgoing on at others. There was partialanchylosis between the tibia and astra-

galns, also between the latter bone andos navicnlarc ; between the cuboides andos calcis, the disease was extending its

ravages. The synovial membrane was

very much thickened, the cartilage nice-rated in several parts, and the extremi-ties of the bones very soft. The liga-ments of the joint were converted intosemi-gelatinous pulpy masses, and a por-tion of the outer side of the astragaluswas loose and diseased.

Mr. LAWRENCE’S Lecture on the Pnrn-lent Ophthalmia of Adults will appearin our next; and Mr. ALcocK’s Lee-tures will be concluded In the presentVolume.