35.

to the stomach and bowels; bottles filled with hot water tothe feet, and cold lotions to the head. As thirst was urgent,small quantities of cold water were allowed as a drink. Thediet to be chiefly farinaceous, with small quantities of soup, &c.On the following morning I found my patient much better,

although she had passed a restless night, her sleep havingbeen much disturbed by dreams. Her pulse was 60 and soft,and her breathing 30. She complained of slight headache andof a burning pain in her stomach and bowels, both of whichwere tender on pressure; her tongue was dry and slightlycoated, and her pupils natural. The poultices to be continuedto stomach and bowels, and occasionally the lotion to head.An ounce of castor oil to be given immediately; diet to bebeef-tea thickened with arrowroot ; the other treatment to bediscontinued.On the day following she was convalescent.Remarks. -In cases of poisoning it is certainly of importance

to ascertain early both the kind and quantity of the poisontaken. In this case the symptoms were so well marked andcharacteristic that there was no doubt as to the former, andit was also evident that the amount taken must have beenvery considerable. I shortly afterwards ascertained from theveterinary surgeon that the liquid was Fleming’s tincture un-diluted, and that the phial, which the girl states she drainedat one draught, was more than three-quarters full. Had shenot repented of her rash act and disclosed all to her mistress,she probably would never have been seen alive. In somemeasure, too, she owes her life to the circumstance of herstomach being full when she took the poison, to the quantitiesof milk given afterwards, which must have considerably re-tarded the absorbing process of the stomach, and to the almostnon-volatile nature of the drug. In similar cases the prognosiswill be more or less favourable as the stomach happens at thetime to be full or empty.

Stranraer, N.B., May 14th, 1866.

CONFESSIONS OF A LAUDANUM-DRINKER.

BY W. WHALLEY. ESQ., M.R.C.S.

IN obtaining the following brief and somewhat immethodicalfacts I experienced some little difficulty, owing to the reluct-ance evinced by the patient to reveal the true magnitude ofher infirmity. For many years her demeanour was so circum-

spect that some of her most intimate acquaintances were notcognisant of the fact that she did imbibe laudanum. The sub-

joined particulars were fully corroborated by her husband, andtheir veracity is perfectly reliable.On March 19th, 1866, I was consulted by Mrs. K-, aged

forty-four, who has had eight children, three of whom areliving, their respective ages being eighteen, sixteen, and sixyears. She is about the average height, rather inclined tostoop, and moderately stout. Her hair is very grey, and hercountenance had a rather withered, yellow aspect. Her eyeswere glassy, and the conjunctivas straw-coloured. When askedto put out her tongue she did so tremblingly, which was coatedwith a brown fur. She complained of headache, loss of sleepand appetite, intense thirst, and her bowels were slightly re-laxed. She stated that owing to recent domestic adversitiesshe had indulged in whisky as well as laudanum; of thelatter, the average quantity taken the last eighteen monthshad been a gallon a month. During this period the stomachhas frequently retaliated and rejected its contents. She ex-pressed a determination to relinquish the habit gradually ifpossible, believing that death would be inevitable if the accus-tomed stimulus was suddenly withdrawn.About fourteen years ago she suffered from severe pain in

the bowels, for which a friend advised her to take twentydrops of laudanum. This she found to afford the desired relief,and on each accession of pain at once resorted to the aboveremedy. In course of time the pain ceased to annoy her ; buta desire for the laudanum had almost unconsciously beenacquired, and unfortunately more courage and resolution wereessential to its abandonment than fell to the lot of its victim.The habit became more and more confirmed, the craving forthe stimulus became increased, and in order to produce thedesired effect the dose was constantly augmented, so that afterthe lapse of a few years she was capable of taking a quart aweek. More than this the stomach would not tolerate. Itseffects upon her spirits were most exhilarating. She felt lively

and cheerful, and could accomplish almost any amount ofhousehold work ; and instead (as is often the case) of sufferingfrom constipated bowels, with accompanying headache, theywere invariably relaxed, and there was entire freedom fromheadache. She slept well, her appetite was remarkably good ;in fact, there was very little, if any, disorder of the digestiveorgans. The organs of sense did not exhibit any signs orsymptoms of impairment, except that of sight, which was notquite so good as formerly. If deprived of the laudanum for asingle day, the most unpleasant symptoms came on : loss ofsleep and appetite, and an indescribable feeling of languor,with a corresponding depression of spirits, and slight involun-tary motions of the limbs, all of which were readily relievedby the accustomed dose of laudanum.When first consulted by my patient, I fostered the most

sanguine hopes of being instrumental in enabling her to conquerher defect. The whisky was discontinued, and the doses oflaudanum decreased, and by the aid of salines, so., her dis-tressing symptoms speedily vanished, her appetite and usualflow of spirits returned, and she was soon engaged in her cus-tomary domestic duties. At this period, however, my hopeswere suddenly and unexpectedly doomed to disappointmentfrom the absurd intelligence I received from her nearest rela-tives-namely, that it was their intention to allow her thelaudanum, but in smaller doses, they being infatuated with theidea that to discontinue its use entirely would be to endangerher life.

Bradford, Yorkshire, July, 1866.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

MIDDLESEX HOSPITAL.COMPOUND STELLATED FRACTURE OF THE SKULL, WITHEXTREME DEPRESSION OF PARTS OF THE FRONTAL AND

LEFT PARIETAL BONES; WOUND OF THE BRAIN, ANDPROTRUSION OF CONTUSED CEREBRAL MATTER; A PIECEOF THE FRONTAL BONE REMOVED BY THE TREPHINE,AND THE DEPRESSED BONE RAISED ; RECOVERY.

(Under the care of Mr. GEO. LAWSON.)

Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborumet dissectionum historias, tum aliorum, tum proprias collectas habere, et interse comparare.-MoRGAGNI De Sed. et Caus. Morb., lib. iv. Procanuuin.

IN cases of depressed fracture of the skull it is always aquestion whether or not an operation should be performed forthe purpose of raising the depressed bone. The late Mr.Samuel Cooper laid it down as a rule never to be departedfrom, " that existing symptoms of dangerous pressure on thebrain can alone form a true reason for perforating the cranium."The wisdom of this maxim is now acknowledged by most sur-geons ; and few, if any, would venture to use the trephine fora depressed fracture of the skull if the patient did not at thetime exhibit unmistakable evidence of pressure on the brain.Recoveries after severe and extensive fractures of the skullhave been so often recorded, that, where no dangerous cerebralsymptoms exist, there is always a hope, although it may be afeeble one, that the case may do well. A notable instance ofsuch a recovery has just been brought again before the publicin the Memoirs of Sir Philip Broke, Bart., who, in the famousengagement between the Shannon and the Cheasapeake in1813, received a desperate wound of this description. Thecircumstances are thus noted in the work:-" Broke parriedthe pike of his first assailant, and wounded him in the face.Before he could recover his guard the second foe struck himwith a cutlass on the side of the head; and instantly on this,the third American having clubbed his musket drave homehis comrade’s weapon until a large surface of the skull was

36

cloven entirely away. The brain was left bare. Broke sankof necessity, stunned and bleeding, on the deck." Sir Philipdied, an admiral, in 1841.The two following cases are interesting examples of fracture

cf the skull with depression. In Mr. Lawson’s case there wasan extensive stellated fracture with depression, and positivesymptoms of pressure existed when the lad was brought intothe hospital, within a few minutes of the accident. The boywas insensible, partially paralysed, with a marked externalsquint, and breathing stertorously. The skull was not onlyfractured, and large fragments of the bone depressed, but thebrain was injured, and some cerebral matter was exuding fromthe wound. In this case there could be no question about thepropriety of using the trephine or of performing some operationfor the relief of the dangerous symptoms. A small piece ofthe frontal bone was accordingly removed with the trephine,and the depressed bone raised. The lad derived immediaterelief from the operation, consciousness was soon regained, andwithout a single untoward symptom, not even so much as aslight pain in the head, he has progressed steadily towardsrecovery. The wound is now completely cicatrized, and heLas grown fat since his residence in the hospital. The casewill be carefully watched, as from the injury of the anteriorlobe of the brain some epileptiform attack or even an amauroticcondition of the eye may be dreaded, as both epilepsy and iamaurosis have been found occasionally to follow, after some ’,interval of time, such injuries.

In Mr. Nunn’s case there was a fracture of the skull withsome depression of bone, yet no cerebral symptoms existed toshow that it was exerting any prejudicial influence on thebrain. No surgical interference was called for, and the man,without a bad symptom, made a rapid recovery.Edwin B-, aged twelve years, was admitted on April

17th, having just fallen from the second-floor window on tothe stone pavement beneath. He was engaged cleaning 9windows, and was standing on the window ledge, when, fromsome unexplained cause, he let go his hold and fell to theground, a height of thirty feet, his head first coming in contactwith the pavement, and receiving the full force of the fall.On admission he was quite insensible; body and extremities

cold and moist; face blanched; pulse small, about 60. Overthe left eyebrow there was a lacerated wound about one inchin length. On passing the finger into the wound, a fracture ofthe frontal bone was at once detected ; a large portion ofbone was felt depressed about the eighth of an inch, and a partof the side of the head, about the size of the palm of the hand,seemed flattened. There was an external strabismus, and para-lysis of the right arm. The pupils of both eyes were con-tracted to their greatest extent. There was bleeding from thenose. The right eye was projected slightly so as to be dis-tinctly prominent, and the lid and tissues around it wereblackened from effusion of blood into the cellular tissue of theorbit, probably dependent on fracture also of that part of theskull.The boy was at once taken into the theatre, to allow of a

more thorough examination being made than could be donewhilst the patient was in bed. Mr. Lawson enlarged thewound over the left eyebrow to ascertain the extent of thefracture and the depressed bone ; but as the cutting causedthe boy to jerk his head about, chloroform was administeredto him, until he was completely under its influence. On en-

larging the wound, a large stellated fracture was found. Theskull was split in three lines, which radiated from a point justabove the inner angle of the left brow ; and three large piecesof bone were jammed in towards the brain, giving the side ofthe head the flat appearance noticed on admission. At the

point where the fissures met brain-matter was protruding.By applying a small trephine on the sound bone close to thepoint from which the fissures radiated, and thus removing apiece of the frontal bone, and afterwards by snipping off witha pair of curved bone forceps two or three points of bone which- vvere in the way, Mr. Lawson was enabled to pass the elevatorbeneath each of the three depressed portions in succession, andto raise them to the level of the healthy skull. The momentthe first and most depressed piece was raised, the boy, thoughunder chloroform, gave an involuntary jump. The vault ofthe skull having been now completely restored, the freshlyincised part of the skin was brought together over the tre-phined part, and united by two wire sutures, a piece of wetlint being laid loosely over the wound.Ten P.M. (seven hours after the operation). -The boy ÍE

sensible ; has passed his urine ; the left pupil is now of normalsize; the right eye cannot be examined on account of theecchymosis of the lids ; skin hot and dry ; pulse 120.

April 18th.-Has passed a quiet night ; pulse 92, rather

feeble, but soft. He is quite sensible, but drowsy, and doesnot speak unless loudly spoken to, when he will answer anyquestion. He put out his tongue when told. There was nodeviation of it. The apparent paralysis of the right arm andthe strabismus have quite disappeared. The pupil of the lefteye acts well. The bowels have not yet been relieved. Or-dered an ounce of castor oil and a pint and a half of gruel as anenema. As there is considerable swelling about the scalp-wound, to apply iced-water dressings. To be given liquid food,such as beef-tea, milk, arrowroot, &c.; but no stimulants.

19th. —Was delirious during the night; but is quite sensiblethis morning. He is still very drowsy. Pulse 104; tonguemoist. The cedema of the right eyelid is sufficient to keep theeye closed. The enema did not act yesterday. Ordered, oilof turpentine, half an ounce; castor oil, one ounce; gruel, a.pint and a half : to be given immediately. The wound islooking well; the swelling is subsiding. He takes his nourish-ment freely.

, 20th.-The enema acted thoroughly. He has passed a good.night. Tongue moist and clean ; pulse 80, and of good power.He is now quite sensible, and answers questions readily. Thedrowsiness has passed away; takes his food well; wound granu--lating.From this date the boy has progressed steadily. He has

never had any pain in the head, or suffered from any annoy-ance of any sort. He has shown himself to be a sharp, intel-ligent boy.May 25th.-The wound is now quite healed. The boy looks

and feels well. The bowels act regularly every day withoutmedicine; and, since his admission into the hospital, he hasgrown fat. He is still kept very quiet, and not allowed toexcite himself by talking much to the other patients.We saw the boy last about the middle of June. He was.’

perfectly well, and playing about in the hospital garden.COMPOUND FRACTURE OF THE VAULT OF CRANIUM, WITH EX-

TBJSSIVE DEPRESSION OF THE RIGHT SIDE OF THE FRONTAL

BONE ; COMPLETE ABSENCE OF SYMPTOMS; RECOVERY.

(Under the care of Mr. NUNN.)E. M-, aged forty-eight, admitted April 3rd, with two

small wounds, an inch and a half apart, at the anterior

boundary of the right temporal region; the right side of theforehead was, so to speak, knocked in. A probe passed intothe wounds mentioned could be made to catch against the edgeof the bone not depressed. The patient was able to give an.account of the accident, which appeared to be a fall head fore-most of eight or nine feet on to stone paving. Tolerably freebleeding had occurred from the wounds, and there was some-,subconjunctival ecchymosis. The patient passed a bad nightafter his admission, and vomited frequently. Pulse 100. He was

placed on milk diet, and cold lotion was applied to the head.April 6th.-Twenty grains of sulphite of soda in pimento

water three times a day.9th.-Tongue whitish; no symptoms. The sulphite to be

continued ; broth diet. ’

13th.--Slight blush around the wounds, which are healing.Collodion to be applied over the red part, the orifices of the-wounds being left uncovered.

17th.-Blush disappeared ; wounds healed. Chop and-porter.May 4th.-Discharged well. Strictly cautioned to avoid

excess.

The sulphite of soda was continued throughout as a prophy--lactic against pyaemia ; it did not produce purging.

In the case reported in the "Mirror," May 19th, under thecare of Mr. Nunn, the hyposulphite was also given, but notuntil rigors had occurred. Up to the date of the rigors thatpatient had been progressing more favourably than might havebeen expected. Impressed with the uselessness of the remedyafter the declaration of the purulent infection, Mr. Nunn pre-scribed the hyposulphite on the third day after admission inthe case we have just detailed.

There was lately under Mr. Nunn’s care in the hospital aman, aged thirty-one, who a fortnight previously had fallen

backwards from a stage about seven feet above the crown ofthe arch of the Metropolitan Railway tunnel, which is covered

; with asphalte. There were marks of contusion of the occiput,and he complained on admission of pain on one side of the

; chest, but no fracture of the ribs was detected. There hadbeen no serious symptoms of injury to the brain, but thememory and other mental faculties seemed to have undergone a,shock. He could not tell his age within ten years, nor did he