33

are to be considered, therefore, as methods of atrophy-as de-fects rather than as perversions of the nutritive process, or asdiseases only in consideration of the time of their occurrence." "The following cases afford illustrations of extensive changes

occurring in comparatively early life, and dependent on one ofthose causes of atrophy and degeneration of the bloodvesselsto which reference has already been made-viz., inebriety;and when we reflect on the gross and artificial life led by thehabitually intemperate man,-the wear and tear to which theconstitution is subject through the continued antagonism oflethargy and stimulation induced by the introduction of iiar-cotic and irritant fluids,-the constant excitation of thirst andsure subdual of hunoer,-the waste of nervous energy and lossof muscular power, &c., can we wonder that he should, as acommon rule, fall an easy prey to disease, or his life be readilycut short by injury, when the system is already so underminedby this self-inflicted, slow poisoning? and might we not fairlyexpect that, after death, the circulating fluid, with the varioustissues of the body, would afford abundant evidence of chemicaland physical changes stealthily, but surely, wrought by thistoxaemic power? ‘ If," says Dr. R. G. Dods,’ "the thought-less consumers or zealous advocates of stimulating beverageswould accompany us to a few post-mortem examinations of in.dividuals who had persevered in such hal its, or were called towitness, like us, the sufferings they previously endured, theywould feel horrified at their own folly and ignorance, and, ifthey were wise, would never touch the bowl again."

(To be coM{):Ke<7.)

POISONING BY GOULARD’S EXTRACT OFLEAD.

BY C. J. B. ALDIS, M.D.,MEDICAL OFFICER OF HEALTH FOR ST. GEORGE’S, HANOVER-SQUARE.

Lucy Ann C-, aged twenty-one,,an unfortunate female,residing at No. 12, Commercial-road South, Pimlico, was at-tacked on Saturday night, Dec. 24th, with pains in the abdo-men ; and having stated that she had swallowed a lotion con-tained in a bottle marked "Poison," and used for leucorrhaea,the doctor was sent for. He visited her immediately, at tenr.M., and found her in excruciating agony. There was violent

pain in the epigastric and umbilical regions, which the patientfrequently rubbed; the muscles of the belly were drawn in-wards. The pain had commenced in the back and extended tothe abdomen, and was of the same character as that producedin very violent colic. The pulse was extremely feeble, withtremor of the hands, and constant jactitation, the patient rock-ing her body from side to side as she writhed under her suffer-ings. It appeared that, being " unhappy," she wilfully swal-lowed, at first, small doses of Goulard’s extract of lead,which were increased until about three quarters of a pinthad been taken, when the symptoms became exceedinglyurgent; they were also accompanied by heat in the throat andabdomen, with an anxious wish to vomit, and intense thirst.Her screams caused the superintendent of the house to visither and to send for medical assistance.A scruple of sulphate of zinc was administered, but as it did

not act so soon as might be wished, another scruple was given,which soon caused vomiting, but not to a sufficient extent. Asolution of sulphate of magnesia was then taken, which wasfollowed by very copious vomiting with marked relief to thesymptoms; and, with the exception of obstinate constipation,the patient is going on favourably.

Chester-terrace, Chester-square, Jan. 1S60.

DETECTION OF BLOOD STAINS.&mdash;In medico-legal in-quiries, it is often of the utmost importance to determine thecharacter of red spots on linen or steel, supposed to be bloodstains. M. Brucke has recently published the following method,as being superior to those in common use :-" Wash the spotwith cold distilled water. To the reddish liquor thus obtainedadd a solution of sea salt, and evaporate to dryness, in ’1.’acuo,over a vessel containing sulphuric acid. Examine the dry re-sidue well through a microscope, in order to verify whether itcontain any matter that might be mistaken for Tetchmann’scrystals; then add a little highly concentrated acetic acid;evaporate again to dryness; moisten the residue with water;and then, if there really be blood in the spots, the microscopewill reveal unmistakable crystals of haematin."* Report from the Select Committee on Inquiry into Drunkenness, p. 235,

printed by Order, 3lay 5th, 1834.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

LONDON HOSPITAL.

WOOD’S OPERATION FOR THE RADICAL CURE OF HERNIA,COMPLETELY SUCCESSFUL.

(Under the care of Mr. CURLING.)

Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum etdissectionum historias, tam aliornm proprias, collectas habere et inter se eom-parare.-MORGAGNI. De Sed. et Caus. Mo2-b., lib. 14. Proaemium.

IF we take the great range of surgical science, with its rapidstrides towards conservatism, we shall find really very fewimprovements to be compared with that put in practice withinwe may say the last three or four years for the radical and

complete cure of reducible inguinal hernia. How often hasthe question been asked, why a remedy could not be found tocure a rupture ? And our wonder is that such a malady, whichexperience now proves is so amenable to treatment in earlylife, should have remained for so long a period one of the mostincurable of surgi ’al diseases. We have no doubt that in thecourse of another generation, when the method of performing aradical cure of inguinal hernia has become universally known,very few cases of this form of rupture, unless those suddenlyoccurring, will be seen in elderly individuals. And this leadsto the question-Why cannot the same principles of treatment,only differently applied to suit anatomical differences, be re-sorted to for the cure of femoral hernia, which is the cause ofdeath in so many females from neglected strangulation, and itsunsuccessful, because tardy, means of relief?The first series of operations for the radical cure of hernia

were performed by Wutzer, of Bonn, who devised an instru-ment for the purpose of exciting some amount of inflammationin the peritoneal sac of the hernia, or of its neck, so that itscomplete obliteration should be accomplished, and at the sametime, by means of a plug, closing the hernial aperture, throughinvagination of the integuments. A drawing of his instrument,with a description, together with the first recorded cases in our"Mirror," appear in the second volume of this journal for1856, p. 511, (see also vol. ii., 1857, p. 141.) Several other in-stances from time to time have been placed upon recordin our pages ; many of them cured by Wutzer’s operation, andothers by modifications of it. One of the most importantand successful of the latter was contrived by Mr. Wood,of King’s College Hospital, and now goes by the name ofWood’s operation. It is, indeed, entitled to the rank of a dis-tinctive operation. It is more scientific and perhaps a littlemore difficult than Wutzer’s ; but then the cure is most satis-factory, without the slightest tendency to a return of thehernia. An engraving of Mr. Wood’s instruments, togetherwith a complete description of his operation, have already beengiven, (THE LANCET, vol. i., lb58, p. 531.) In our " Mirror"of December 24th, we briefly dwelt upon its success in fourteeninstances in Mr. Wood’s own hands. The preference wouldseem to be given to it now by many surgeons, not only in Lon-don, but in the provinces.We place upon record to-day four instances in which an ope-

ration for the radical cure of inguinal hernia was attempted:with success in three, and a fatal result in the fourth-thefirst fatal case which has occurred in the hospitals of London,and perhaps in this country. We have watched nearly thewhole of the cases which have been submitted to operationthus far, and success has been the usual result. This speaksmuch, indeed, for the cure of such a common malady, which has

’

disqualified so many otherwise stout and able-bodied men fromentering the public services. We understand that no objectionis made to men who were once the subjects of hernia, pro-vided they have been radically cured in the manner we areconsidering. And neither a sailor nor a soldier, who may be-come ruptured, is disabled from further service if he can beso readily cured. The cure is, if anything, more effectual and

’

speedy in the more recent than in the older hernias.

34

The fear of peritonitis to a dangerous extent, and the absence of adhesion of the parts at the inguinal canal and ring, are the Iobjections that have been raised against this operation. Suchoccurrences are not, by any means, improbable; for one of the I

cases detailed further on, no doubt ended by peritonitis, andin an apparently healthy subject. But if the minimum amountof non-success hitherto experienced be taken into considera-tion, the greater number of surgeons will rank themselves asardent supporters of almost any operation for the cure of re-ducible hernia.The following case of inguinal hernia we saw submitted to

operation on Wood’s principle, and is interesting from the cir-cumstance, as Mr. Curling remarked, that owing to the adhe-sion of the omentum and reduction of the sac, Wutzer’s ope-ration was quite inapplicable. To this fact we would draw par-ticular attention. The operation was so mild that the patien t wasable to return home, a distance of more than a hundred miles,on the eighteenth day after its performance. As no intestinedescended, a milder operation was performed than Mr. Woodusually recommends, and it was not thought necessary to incurthe risk of carrying the needle and ligature so deep as beneaththe conjoined tendon.The details of the operation are clearly set forth in the notes

of the following case, which were taken by Mr. H. F. Haw-thorn, the dresser of the patient :-Henry H-, aged thirty, by occupation a smith, was ad-

mitted on the 7th of November, 1859. He is of a bilious tem-

perament and abstemious in his habits, lives in Somersetshire,has enjoyed average health, and is married. He has been sub-

ject to hernia for seven years. It was produced by the violentexertion required to use the big hammer which is peculiar tohis trade. The tumour was always present during the day;but when he retired to bed, it returned, unaided, into theabdomen. Trusses of various kinds were tried; but as theydid not prevent the protrusion of the tumour, and, besides,gave him unendurable pain, they were discontinued. As thehernia increased in size, and all efforts to restrain it provedfutile, he came up to London, and, by the advice of his sur-geon, placed himself under the care of Mr. Curling, with thehope of having it completely cured by operation.On examining him, Mr. Curling found an oblique inguinal

omental hernia on the right side, of the size of a walnut. Theomentum was adherent to the sac, and easily reducible eHmasse. On coughing, no intestine appeared to descend. Theouter ring was capacious, readily admitting the finger. Fromhis admission to the day of the operation, the man was allowedthe full diet of the hospital, to take constitutional airings inthe garden, and to lie on the bed the greater part of theday.

Dec. lst.-Mr. Curling performed the operation, which wasdone in the following manner, under chloroform: --Havingfirst reduced the hernia, an incision, three quarters of an inchlong, was made in the scrotum, in a line with the spine of thepubis, and about an inch below it. The skin was then dis-sected from the superficial fascia to the extent of an inch in cir-cumference. The next step was to carry the index finger throughthe incision, pushing before it the fascia, into the external ring.A large, firm needle, fixed in a handle armed with a ligature,was guided along the finger to the external pillar of the ring,through which, and the structures lying between it and theskin, it was thrust, and one end of the ligature was drawnthrough the opening. The needle was withdrawn, and the in-ternal pillar was subjected to the same procedure. The skinwas raised by an assistant before the external pillar was trans-fixed, and depressed whilst the internal pillar was pierced, sothat in both instances the needle came out at the same open-ing. A glass pad was then laid on the skin, in the course ofthe inguinal canal, over which the ends of the ligature werefirmly tied. A piece of wet lint was applied to the wound,and the man sent to bed. Ordered milk diet.2nd.-Passed rather a restless night, troubled with dreams,

and a slight cough ; tongue white; pulse full, but not otherwiseunnatural; passed urine freely; slight tenderness, but not morethan might be expected ; no pain in the cord or testicle. Or-dered compound squill pill for cough.3rd.-Not much febrile disturbance; appetite bad; troubled

with wind; cough better; wound suppurating and healthy;tenderness around the ring slightly extended in the course ofthe cord ; bowels moved twice during the day.4th.-Tenderness has increased ; passed a sleepless night ;

appetite bad.5th.--Tenderness about the same ; tongue white ; skin hot ;

passed a bad night; diet causes flatulence, which prevents hissleeping ; wound in scrotum healing. Mr. Curling removedthe tube and ligature, when about two drachms of healthy pus

escaped. To apply a bread poultice ; to have half a pint ofporter and a chop ; bowels moved to-day.

6th.-Better; passed a good night; tenderness disappearing;very little pus; tongue clean.

7th.-Passed a poor night, on account of being disturbed;parts in the course of the inguinal canal rather swollen ; lesstenderness.8th.-Health good; behind the lower wound there is pus,

which, on pressure, escapes at the opening in the abdomen.Ordered full diet.9th.-Passed the best night since the operation; no pus;

parts very much thickened about the canal.12th.-Going on well ; induration about the ring increased;

discharge of pus has ceased.15th.-Wounds healed ; parts firm. Mr. Curling examined

him out of bed, and found the operation perfectly successful.In any posture there is not the slightest tendency to pro.trusion. To get up a few hours every day, and wear a trusswith a large elongated pad and weak spring, to give gentlesupport to the inguinal canal.

18th.-Discharged cured.

KING’S COLLEGE HOSPITAL.

MODIFICATION OF WOOD’S OPERATION ; DEATH.

(Under the care of Mr. FERGUSSON.)

THE patient who was the subject of the following case hada rupture from his birth, but it appears to have been reducedfor some years after the age of fourteen. It, however, returned,from the causes mentioned in the history, and affected bothgroins; that in the left was comparatively recent. The herniawas so great on the right side that the aperture of protrusionwas very much larger than usual, so much so that any kind oftruss was useless. The patient was most anxious to undergoany treatment for relief, and Mr. Fergusson deemed it a faircase for the adoption of Wood’s operation. It will be seen,however, from the description, that the procedure was a slightmodification of the plan proposed and carried out by Mr. Wood.The man succumbed from peritonitis on the fifth day, but, asno post-mortem examination was permitted by his friends, itis impossible to state the true condition of the parts at theneck of the sac. It is the first fatal case which, so far, hasbeen known to occur. For the notes of it we are indebted toMr. Francis Mason, house-surgeon to the hospital :-

J. B-, aged forty-seven, admitted on Nov. 18th, 1859;he is a baker, and has always enjoyed good health, but accus-tomed to lift heavy weights. He says that from birth he ha-had a tumour in the right groin, which increased on his assum-ing the erect posture. He wore a truss up to the age of foursteen, and then considered that he was cured. On lifting aheavy load, however, about twenty years ago, the tumour re-appeared, and has since gradually increased in size. He hasalso suffered, in a less degree, from an oblique inguinal hernia onthe left side, and has worn a truss for it; but, about six monthsago, upon using more than ordinary exertion, he found that atumour, of the size of an orange, and of a painful character,appeared in the left groin. This also had been getting larger.On admission, the patient had a cheerful expression of coun-tenauce, and made little or no complaint. On examining theregions of the hernia, a tumour, of the size of a large cocoa-nutis seen on either side. This increases on coughing, and alsoon his assuming the erect posture, but disappears, to a greatextent, on his lying down. When he is erect, the penis can beseen with difficulty. He has never suffered from constipation,and has had no symptom of strangulation. The bowels areregular, and the functions of the body are healthily performed.He does not complain of pain.The patient, harassed by the unwieldy heaviness of the

scrotal mass, was anxious to have something done to effect aradical cure. Mr. Fergusson, therefore, proceeded to operateon the 19th of November, in the following manner:-Whennarcotized by chloroform, a skin-deep incision, of about aninch in length, was made over the spermatic cord of the rightside. The finger of the left hand was then introduced, andpushed up to the internal ring, carrying before it the subcu-taneous structures. A needle, armed with a strong thread,was then passed up to the ring, guided by the finger, and wasmade to transfix the internal pillar; one end of the threadwas drawn through, and left free. The needle was now with.drawn, and the same steps adopted to transfix the external