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read nor wrtte, men who would neverhave thought of presenting themselves atthe College, had they not known the

Professor’s enormous (twenty guineas) for admittance, would procure them ail

they required.It may be argued, that Mr. Coleman is

there to determine what the other teach ers cannot pretend to. But is it just,that he whose interest it is to admit pu-pils, should alone be their teacher andexaminer; would such members as are init have ever been admitted, had the pi e-sent Examiners displaye(1 that care forthe welfare of the profession, which itwas their duly to exerc’iae? As a Mem-ber of the College of Surgeons, I amalready greatly indebted to you, though Ifear the force of bad example so long andso unjustly continued in that College,will tend to lengthen those I complain ofin ours; for you will observe the majo-rity 01 Veterinary Examiners* are thosewho ale practising the satne tyranny intheir own profession, which you have sooften justly inveighed against.By inserting the above, you will oblige

one of your constant readers,A VETERINARY SUKGEON.

St.Pancras, June 28.

HOSPITAL REPORTS.

HOSPITAL OF SURGERY,Panton Square, St. James’s.

The two following cases show withwhat facility and safety hæmorrhoidaltumours can be removed by the scis-

sors, in comparison to the severe opera-tion by the ligature. In removing tumours of this description with the scissors,Mr. Wardrop observed, that he never savcany trouble-ome hæmorrhage t’ollow sucha mode of operating, unless when inplace of removirg the whole tumour, aportion of it ouly had been cut away. Theconsequence of’ cxtting away a portion is,that in place of only one or more smallvessels being divided along with soundadjacent par ts, an incision is made into adiseased structure. A spongy mass, inwhich blood freely circltlates.

Sir Astley Cooper, Sir E. Home, Mr.Abernethy, Mr. Cline, Dr. Pearson, Dr.Cooke, Dr. Babington, Mr. C. Bell, Mr.Greetr, and Mr. Brodie.

HÆMORRHOIDAL TUMOUR.

Francis H.. set. 44. There is at inter-vals of a few days, and sometimes everyday, a discharge of blood from the rec-turn after and usually to the extentof a pint and a halt; suffers great painaround the anns, particulary before thebleeding takes place. On exam nation,there appear several prolongations of thecommon integuments, and an excrescenceof a bright red colour, which is attachedto the bowel within the sphincter muscle :it can be projected beond the aous bystraining, and always on going to stool.The tumour is about the size of an olive,with a broad base, and an irregular mr-tace, on which can be observed severalsmall perforations, and through which theblood is discharged. This tumour is ex-

tremely tender to the touch. He states,that nine years ago, he had a severe

diarrhœa, which %%a, followed by piles,the bleeding from which began at thetime of their appearance, and has conti-

ever since. He is of a squalid com-plexion,but complains of nothing but weak-

ness, which he attributes to loss of blood.Operation. —The bowels have been

carefully evacuated for some days, andexcept from the effects of the local ail-ment, he seems healthy. The tumour be-

ing made to protrnde, it was Ltid hold ofhy a pair ot hæmmorrhoidal forceps, anddrawn ont so far as to allow a pair ofcurved scissors comltletrly to inclnde thediseased part. The hleedmg was verytrifing. Took two grains ot opium. Inthe evening he experienced considerablepain on going to tool, and a few ouncesoi coagulated blood were passed.

Sixth day. Feel,; himself quite easy,and has lost no more blood. Some oedemawhich was around the anus, is very muchdiminished ; complains only of pain ongoing to stool. Ordered the ol. ricin. toregulate his bowels, and the liquor arrt-mon. acet. to be applied to the part af-fected.On the 8th day he did not feel quite so

well. Pulse fnll, and ratlrer hard; tooka pill containing calomel and rhinbarb,with a dose of castor oil the followingmorning.

Twelfth day. Has now little or no painongoing to stool, and the œdema aroundthe anus is quite gone. To take smalldoses of castor oil occasionally.

Fifcenth day Still complains of slightpain on going to stool, but in other respectshe is much improved in health.On tite 20th day, he left the Hospital

qoite well, with directions to take smalldoses of castor oil occasionally, and toreturn if he should feel headach, giddi-ness, or any disturbance in his health.

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HÆMORRHOIDAL TUMOUR.

George D., aet. 43, a gardener,complainof great pain and uneasiness around the

verge of the anus, more

during and immediately after stool, whenLe generally loses a considerable quantity ot’ blood. On examining the partthere appears au excrescence of th(size of a pigeon’s egg, protrudingbeyond the sphincter clni muscle, iiisot a livid colour and of a soft and

spongy texture, having numerous smallperforations on its surface. There are

several lesser excrescences attached t:the extremity of the bowel; but it is fromthe larger one thtt the bleeding take!place, and which causes so much in-

convenience. The surrounding mte-

guments are very much relaxed—other-wise he enjoys pretty good health. Statesthat five years ago after a severe bowel

complaint, for which he took too large adose of’ the tincture of rhubarb, he observed for the tirst time a small swellingat the verge of the anus, which gave himconsiderable uneasiness. He was advisedto use o which almost cured him,and he remained so for a twelvemonth.At this time he overworked himself, andthe tumour again made its appearancewith i«creased suffering. Is never en-

tirely free from pain. Since this com

plaint commenced tie has at intervals lostsmall quantities of blood, but for the lastyear he h-ts passed several ounces eachtime he has gune to stool.Has been in the Hospital for four days,

during which time his lowels have been

freely opened by castor oil and small dosesof calomel; he feels his health much im-Droved.

Operation.—The patient was directedto sit over hot water and to strain so asto bring the tumour completely down ’,through the anns. The largest hæmor-rhoid was laid hold of by the forceps, andremoved from its root by the curvedscissors. The bleeding wa’- trifling. Hewas put to bed and a cunple of grains ofopimn introduced into the rectum.About half an hour after the operation

he felt a desire to go to stool, when he

passed about eight ounces of clottedblood. In the course of two hours hewent to stool two or three times, and ateach passed about four ounces of blood.He now took two grains of opium inter-

nally, atter which the bleeding ceasedand he remained perfectly quiet. In the

evening the bleeding had not recurred,and he felt easy.On the third day after the operation,

he took 3ss. of casior oil, which operatedwithout giving much pain.

From this Hme he contimted to do well

for seven days, when lie was dismissedfree from complaint, with directions to

t, regulate his bowels and attend to his ge-neral health.

-

t

HÆMORRHOIDAL TUMOUR.

Margaret D. aet. 35, there is a tumourof the size of a pigeon’s egg ’-from The anus, it is of a dark livid coloor,apparently much distended with blood,its surface smooth, and exceedingly pain.ful on being touched. This swelling comesdown only during each motion, and causesthe most excruciating pain until again je.duced, which is generally about half anhour. No blood has been discharged.She is of a costive habit, and has nomotion without medecine, which she sel.dom takes, from the dread of the tumourcoming down.

States that eigitteen months ago she

suddenly felt as if something had givenway at the extremity of the booel, andon examination a targe tumour which slie

says was of the size of an orange wasfound protruding from the anns.she was advised to take a strong dose

of physic, and during its operation suf-fered the most agony.The tumour has since continued togive

great pain during every motionuGon, botsliethinks it is cousideiably diminished insize.The tnmonr was punctured with a lan-

cet, and about eight ounces of a darkcoloured blood discharged. Two grainsof opium were introduced into the rec-tum, and she experienced considerablerelief, being free from a burning heatwhich slie used to snfler on the tumour

being returned.She went home and was advised to ap-

ply leeches occasionnally, and to regulateher bowels with castor oil.

In the extremely tender state of theparts, and great irritability of the wooman’s constitution, it was not thoughtproper to remove the tumour.

WARTY EXCRESCENCE OF THE ANUS.

The following case affords a good ex.ample of that peculiar species of tumonr,called crystæ by the older writers, andwhich is very different in its structure

t’rum the hæmorrhoidal tumour, as exem-plified in the foregoing cases.

Elizabeth T. æt. 3U. There is a smalltumour attached by a narrow neck to theverge of the anus, of the size of an olive,firm in its consistence, of a pale colour,and has a notched appearance at itsedge like the comb of a cock. Says that

473

the never experienced any inconveniencetill about six weeks ago, immediately aftera several attack of , when the pre-sent tumour made its appearance, andhas con tinued since ot’tlie same bulk, ant)has never returned within the anus. The

pain and inconvenience were at firsttrifling, but have been gradually becom-ing worse. She suffers most during, andimmediately after stool, and has also iu-convenience in walking.

Operation.—The excrescence was laidhold of by a pair of hæmorrhoidal forceps,and excised with the curved scissors;thele was little or no bleeding.On making a section of this tumonr,

instead ot the congeries of dilated vessels and cellular structure communicating withthese vessels, which is met with in thf haemorrhoidal tumour, the section, inthe present instance presented a firm and rather tough pale-coloured huhstance, ofwhich the whole mass was composed. Instructure, It resembled very much thewarts which form on tho·e parts of thebody where tite skin and mucous mem-braiies unite.Second day.-On going to stool this

morning, telt considerable pain at the

anus, but otherwise is doing well. Totake ol. nicini gss. to-morrow morning.Ninth day. Since last report she has

been daily more free from p4in on going to stool, and feels quite well ; the woundis almost healed.

FISTULA IN ANO.

John M., xtat. 38, a footman. Thereis a small fistulons opening cloe to theverge of the anus, and on introducing a

probe, a cavity is found to extend more than an inch upwards, along the course otof the rectum, and between it and the

sphincter muscle there is a considerable

degree of hardness underneath the inte-giinients adjacent to the fiatula. A dis-eliaige of purulent matter takes place atintervals of two or three day.", which hehas observed tor the lnst six weeks, andstates, that two months ago, on gettingont of bed, he felt, without any evidentcause, an arute pain around the anus,which afterwards continued, thoughleerlies, fomentations, and internal medi-cines had been employed. He suffers a

good deii of pain, but has no other com-plaint.

Operation.—His bowels have been keptmore open than usnal, and he has livedmoderatcly for ten days past. The firststep of the operation consisted in ascer-

taining the extreme termination of thefistulous cavity, and it was found to comeinclose contact with, but not to penetrate,

the coats of the intestine. ’ The interme.diate portion of gnt and cellular snb-

stance was divided with a bistoury. Tworamifications of the fistulons cavity, ex-tending upwards, and another down.

wards, were in like manner laid open.The internal surface ot the cavity waslivid, with a firm substance, having a

smooth slippery surface. A small pieceof lint was inserted between the dividededges, in ordsr to prevent their adhesion,and a poultice applied.He passed a good night after the ope-

ration, and next morning felt no uneasi-ness. The wound went on granulating,

and the adjacent callosity daily diminish-ed. The bowels were kept open by smalldoses of castor oil every second day, anda ponttice continually applied.On the 20th day after the operation,

the wound had perfectly healed, and heleft the Hospital with directions to regu-late his bowels with the ol. ricini.

FISTULA IN ANO.

George P., aet.46, a butler. There ison the left side ot the anus, about an inchfrom its verge, a small opening, whichdischarges a thin puritorm matter. On

introducing a probe, a canal can be traced,extending upwards towards the gut aboutan inch and a half, but does not commu-

nicate with it. Suffers no pain,but greatinconvenience from the discharge of mat-ter. General health tolerably good, withthe exception ot a slight and habitualcough. Say. chat his complaint begantwo years ago, when he first observed asmall swelling in the vicinity of the anns,which at times gave him a good deal ofpain. He used no remedy, audit is onlyabout six months since he first observedthe discharge. Malter has since escapedat short intervals, which alway.-, givesrelief. Can ascribe no cause for this

romplaint; has from his own account

always lived moderately, and been of aregular habit.

Operation.—Has been three days inthe Hospital, and has taken a calomelpill, and two doses ot castor oil, so thathis howcls have been ti-eely evacuated.The operation was performed in the usualway, with the exceptiou that a wooden

conductor, introduced into the rectum,sel ved the purpose of the finger. Theextent of the sinus being ascertained withit probe, a straight sharp-pointed bistourywas introduced along the probe, and itspoint carried through the rectum into thegroove of the wooden conductor, thewhole sinus was then easily laid open byone stroke of the bistoury ; the hæmor-rbage was trifling; two grains of opium

474

were immediately introdnced into the rpetnm, and the patient put to bed.The pain soon subsided after the opera -

tion. and he passed the day tolerably easy.Took a calomel pill at bed time, and a

warm ponltice was applied over the part.On the fourth day after the operation,

the wound was examined, and grannula-tions had begun to spring np. Orderedsmall doses of castor oil every morning.On the 8th day, he complained much of

a sensation of’ itching in the vicinity ofthe anus ; and on examination, a small

opening was discovered near the wound,from which matter oozed. This open-ing led into a sinus, which was tracedwith the probe within the anus; and itwas immediately laid open. In conse-

quence of there being no external fistulousorifice, when the first operation was per-formed, and no communication betweenthe two sinuses, this second sinus had

escaped an attentive search made at thefirst operation. In operating for fistulæ, toomuch pains cannot be bestowed in findingout every ramification of the fistulous ca-vity, and in laying them completely open.

In this patient the wounds granniatedqnickly, and on the twentienth day theyhad perfectly healed, when he left the

Hospital, with the same directions for hisfuture management as were given to theformer patient.

ABSCESS OF BURSA OF THE PATELLA.

John D., a cabinet maker, set. 35. Thereis a latge abscess situated over the pa-tella, the integuments of which are ex-tremely thin, and of a livid purple colour;the neighbouring parts partake of the in-flammation, and are considerably swelled;suffers excruciating pain, and has passedseveral sleepless nigiats. Tongue furred,skin very hot and dry, pulse accelerated.A fortnight ago he received a slight woundfrom a rnsty naif, whi(’h at the timecaused little pain, and he paid no atten-tion to it ; he continued to work, and atthe end of a week the knee began toswell and become painful, attended withfever; since then he has been confineci tobed, and the pain and swelling have in-creased. A free incision was made intothe abscess, and about 3iv- of a thick

green pns discharged, which gave imme-diate relief; a poultice was applied to

the knee, and he took at bed-time acalomel pill, with two grains of opium.

Second day. Passed a better night thanhe has done since the swelling began ; agood deal of ptis and sernm was pressedout ; the integuments are retracting ; isfree from fever ; bowels not open, skin

moist, pulse quick; to take 3iss of thesenna mixture, and the poultice to becontinued.Third day. Continues to do well, and

is almost free from pain. Continue.Eleventh day, ’]’lie skin is now reduced

to its natural size, and is free from pain;the wound in the integuments is almosthealed ; has little ar no difficulty inmoving his leg; liealtli perfectly good,Dismissed.

PRETERNATURAL COJ.J.ECTION OF SYNOVIAIN THE BURSA OF THE PATELLA.

A young woman applied for advice onaccount of a considerable swelling overthe patella of one knee. It evidentlycontained a fluid between that bone andthe integuments, and was not accompa-nied with much inconvenience eBeeptwhen she knelt on it, to which she attri-buted the formation of the tumour, beingfrequently employed in washing floors.The emplast. ammoniaci c. hydrargyro

was applied, and she returned in ten daysmuch relieved. This application is con-sidered by some surgeons as a specific inthis disease.

BLOOD EFFUSED IN THE BURSA OF THEOLECRANON.

There is a globular tumour al)ont thesize of a pigeou’s eg, situated ou theolecrauon of the right elbow. The inte-guments are reddened, and there is a

distinct fluctuation throughout the swell-

ing. About eight weeks ago he fell andbruised this part, from which he found noinconvenience until a month ago, whenthe present swelling suddently made itsappearance. He ha, apptieri leeches andblisters without producing any alterationin its size. The tumour was punctured,and a sanguineous fluid discharged; amoderate degree of pressure was applied1)y a compress and bandage. he re-

turned to the Hospital a week after-

wards, the tumour having assumed nearlyits former bulk. It was again punctured,and a partly transparent slightly viscid,and partly sanguineous fluid discharged.Pressure, by adhesive plaster, was em-ployed. The fluid did not again collect,A ttie end of a fortnight the tumour hadquite disappeared, and the integumentsassumed their natural appearance.

The two following cases point ant thepropriety of examining wounds, iu ordeeto detect the presence of extraneous sub-stances which may be accidentally em.hedded in them; and they show the severe

475

affects which resnlt from a want of atten-tion to such examinations.

PIECE OF GOJ.D WIRE EMBEDDED UP-

WARDS OF THREE MONTHS IN THE

CORNEA.

Morris L., aet. 32. On the temporaledge of the cornea of the left eye thereis an opaque spot ; the pnpil is irregularand adheres to the opaque spot of thecornea; there is considerable redness ofthe white of the eye and great intoleranceof light.About fourteen weeks ago, when twi’t-

in;; apiece of gold wire, a small portionof it broke off and struck the eye. Thteedays after the accident intense inflamma-tion came on, with severe pain, whicheontinned for five weeks and resisted ac-tive depletion. From this period the

pain has become less acute.A few days after applying to the Hos-

pital, a portion of gold wire was observedprojecting beyond the surface of the cor-nea, and a considerable portion seemedto be impacted in the opaque spot. Itwas easily extracted by means of a pairof forceps, and was followed by a dis-

charge of the aqueous hnmonr. The por-tion of wire was of considerable length,fully three lines, and one extremity hadpenetrated the anterior chamber. Felt moch relieved immediately after the ex- tractior of the exciting cause, and theinflammation and opacity soon subsided.

A PIECE OF GLAS EMPACTED THREEYEARS BELOW THE INTEGUMENTS OF

THE FINGER.

The shopman of a chemist received a

wound on thp palmer side of the secondphalanx of the middle finger, in conse- ience of a phial breaking in his hand.The wound was dressed, and heated byadhesion, and the man continned to usehis finger, though a small lump remainedbelow the cicatrix. It continued in thisstate from December 1822 till April 1826,when a slight degree of inflammation tookplace; suppuration ensued, and on a

small opening being made with a lancet,apiece of glaas was discovered. By thedilatation of the opening, the glass waseasily removed, and it proved to be a por-tion fully the size of the nail of the littlefinger. The patient got well imme- idiately.

GUY’S HOSPITAL.

I SEVERE CA4;E OF TIC DOULOUREUX, SUC-CESSFULLY THEBTED BY THE EXHIBI-

TION OF SMALL DOSES OF CARBONATEOF IRON.

The following case of tic douloureux inthe facial nerves, which was of unusualseverity, and of’long duration, was curedby the continued exhibition of carbonate ofiron, in doses of half a drachm three timesa-day. Sulphate of qninine, conjoinedwith opium, was previously administeredfor some time ; recourse was also had tothe division of the iufra-orhitary nerve,both of which measures alike failed inproducing any beneficial effects. We viewthis case as interesting, not only that itis an additional confirmation of the effi-cacy of carbonate of iron, iu this mostdistressing and painful malady, but be-canse it tends to prove that small dosesof this medicine are equally serviceablewith the enormous doses lately adminis.tered !The profession is indebted to Dr. El-

liotson for a knowledge of the fact, thatcarbonate of iron may be given in dosesof half an oonce. We believe that Dr. E.

was the first person who ventured to pre-scribe this medicine in such large doses,and he has given the result of this prac-tice in a paper contained in the last vo-

of the Medico-Chirurgical 1’ransac-tions. It would appear, that Dr. Elliotsonis dubious as to whether there is any ad-vantage obtained from giving large qnan-tities, for although he indulges in a little" analogical reasoning,’ yet he admitsthat " a drachm dose may perhaps be asuseful as one of half an ounce." If suchbe the fact, for our part we should preferthe former dose.

Case Heater Martin, atat. 35, a mar-ried woman, of light complexion and shortstature, came into the Hospitat on 17thof May, nnder the care ot’ Mr. Key, on ac-account of tic douloureux affecting thenerves of the face.The patient states that she has been the

subject of this painful disease upwards offive years, that hhe is occasionally freefrom pain for a few days, and that thedisease is always greatly aggravated dnr- mg the summer season. The pa n whichshe now experiences is so much diffused,that it is difficult to ascertain in what

particular set of nerves it is situated. Itwonld appear from the patient’s descrip-tion, that the disease commenced in oneor more branches of the portia dura, forshe distinctly refers to a particular part