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delivered in the lecture -roomwas calculated to make thestrongest impression on theclass. In the - next. evening’slecture Mr. GREEN proceeds tothe operation of extraction.

HOSPITAL REPORTS.GUY’S HOSPITAL, FEB. 21.

Amputation of the hip-joint. continued. = ’

. This -man has been considera-bly -better, during the past week,and the diarrhœa has left him.His sleep ,. good, but his appe-tite continues bad. His counte-naxioe is sallow, and he appearsextremely weak; the stump isnearly .healed, but opposite tothe- acetabulum - matter can be

distinctly felt. There is a slightdischarge from thewound..

No operations, have been per-, formed here this week.

PHYSIOLOGICALEXPERIMENT.

The following curious expe-riment has been lately tried byDr. BLUNDELL, lecturer on mid-wifery at this hospital. Thisgentleman opened the commoncarotid of a dog, .-and allowedthe artery to bleed till-the ani-mal appeared dead; when Dr.B. immediately injected into thejugular - vein, the blood thatbeen drawn off, which had theeffect of resuscitating- the dog. -From the result of this experi-ment, Dr. BLUNDELL- infers,that when the vital. powers ap-pear to be extinguished in a wo-man during- parturition. from ute-rine hœmarrhage, there is a

chance of restoring animation bythe immediate injection of blood

into the jugular vein. Whe-ther the blood to be injected isthat of the patient herself, or

of some animal which is to bekilled for the purpose, we arenot exactly certain, but we be-lieve the former. -

ST. THOMAS’S HOSPITAL,

MARY MORRIS, æt. 38, wasadmitted into St. Thomas’s Hos-pital, Feb. 5th,. 1824, ’under’ thecare of Mr. TYRIRELL, with anenlargement. of the right paro-.tid gland. Says that aboutseven years ago she was seizedwith, an apoplectic fit, from theeffects. of which, - she did notcompletely recover for severalmonths, being troubled with asevere pain in the head,- paxti-cularly towards evening Inabout six or seven months fromthe time, she had tlze fit ; the.head-ache left her, and was fol·-lowed by -a -giddiness in thehead,. and dimness before theeyes, which has continued moreor less, ever since-with thisalteration only,- that for the lasttwelve months, ithas been con-fined to the right side -only.Five , years ag’o, she first per-ceived a small, hard, and roundswelling, just below the rightear. It continued in this statefor two years, without produc-ing- the least inconvenience ; atthe expiration of which period,it began to enlarge a.nd ,give herpain at times. At,the end of fouryears from the first appearance ofthe.- tumour, it attained half itspresent size,. having -increasedmore within this last,12 monthsthan it had done all .the timebefore. For the several last

259

months she has had a difficultyof swallowing her saliva, dry-ness of the -throat, paralysis of

the orbicularis palpebrarum (not’being able to close’the righteye); inclination of the -muscleof the, face towards the right

ear, a discharge of puriformmatter from that ear, and -a‘ bad’

,:taste in the mouth, which cameon immediately after the dis-charge just mentioned,- and - asensation F in the ear, as if

something was about to comeout.

- - _

’

Description of the Tumour.- The= tumour is of a conicalshape, the base being broad andsituated between the angle of thejaw and the mastoid process ofthe temporal bone, and ex-

tertding also from just oppositeto the tragus anteriorly to littlebehind it. The point is soft, ofa pale red colour, and has a fluc-tuating feel, the base is hard butmoyeable. Various means havebeen adopted previous to her’admission, but with little advan-tage. - Six leeches every night ’,,.for six weeks were applied tothe tumour which how-ever didnot reduce it in size, but greatlyrelieved her head. It has alsobeen opened twice with a lancetwhich allowed of the dischargeof blood only. The openingssoon healed-poultice and lo-tions have been also tised:

.

Her general health is prettygood. Since this patient hasbeen in the hospital, ’12 ounces-_of blood have been taken fromthe neck by cupping, and a

blister has been applied to - theright temple. Mercurial fric-tion is employed every night;-and the woman takes five grains

of blue pill at bed-time, by_which means her moutli hasbecome slightly sore, but no re-lief has been afforded to the’complaint. A small puncture’has been also,made with a Ian-cet, which allowed of the dis-charge of a little blood only -The patient is extremelynxious to submit to an

operation in order to have thetumour removed, bitt as the

extirpation of the parotid is an-extremely formidable operation,it requires great considera-’tion before, it is undertaken.’—Mr. GREEN has, by Mr.TYRRELL’S request, seen the’patient ; - but whether anythinghas been decided on, we have,not heard. Next week we will-

give a case which has not yet-been published in any Englishjournal, where the parotid was.lately extirpated in France.The manner of performing’ theoperation is also described.

Case of fracture of the sk2tll;witla slight depression.

-

George Morris, æt. 15, was’-admitted into Jacob’s ward ofthis hospital, Feb. 12th, 1824, at 4, p. -.M. His parents statethat about eleven in the morn-

‘

ing, he was -found on the groundin a field, quite senseless, and’was supposed to have beenthrown from a horse, and kickedby that animal ; as he had beenseen riding a short time be-’before the accident happened.’He was bled by a surgeon,

’*

previous to his admission, which,it is stated, afforded him some-relief.

4’j p. m. -Lies on his side,nearly in a state of insensibility;

260

when spoken to, he makes noreply; but when roused, andraised up in the bed, heanswers any question, butknows nothing about the acci-dent, or his being brought tothe hospital.-Feels sick-andan effort at vomiting alwayscomes on when he is moved.Pupils -not dilated, and whenexposed to the light, contract

readily-breathing stertorous—

pulse 96-and small.Injury to the head. About halfan inch above the right ear, thereis a wound of a semilunar shape,two inches and a half in extent,situated perpendicularly withthe concavity turned, towardsthe back of the head. The

edges of the wound are clean,but the bone beneath may beseen denuded of its periosteum ;and on introducing the fingerinto the wound, a fracture maybe distinctly felt.Under these circumstances he

was ordered by Mr. TRAVERSto be carried into the operatingtheatre for the purpose of en-

larging the wonnd and ascer-taini-ng the extent of the frac-ture. An incision was made inan oblique direction,cmssing theother, by which means four an-gular flaps were formed. Thesewere turned back, and a fracturewas found nearly of the samesize as the original wound ; andthe bone appeared a little de-,pressed. On examination, how-over the injury was found to beconfined to the outer table. The- elevator was employed to raisea piece of bone iu the centralpart of the fracture. After thiswas done the edges of the woundwere brought together, andover these were put some strips

of adhesive plaster. Jost beforethe operatiou the boy’s pulsewas 108, and fuller than at fouro’clock,—after the operation thepulse became quicker, 120, butsmaller. In removing him fromthe ward to - the’ theatre, the

bandage slipt from the orifice ofthe vein which had been openedin the morning, and some ouncesof blood were lost,

Feb. 14th. A saline effer-vescing draught, with a -little

sulphate of magnesia, was givenhim last evening. Passed a

restless night, and this morn-

ing the pulse became hard and

compressible, and ten ounces ofblood were taken from the arm,after which the pulse becamemore free and expanded.

2, p. m. Pulse 114, full.Tongue whitish brown-Thirs-ty-Skin hot-Pupils dilated alittle-Complains of pain in bothsides of the head-Right side ofthe face very much flushed-Hasnot felt sick at . the stomachsince the morning—Voided hisurine once since his admission,and that immediately after thebleeding’.

N.B. Blood slightly inflamed,and cupped.

Feb. 14th. Passed a prettygood night—Took five grainsof calomel last evening, andafter that a common enema wasadministered, which procuredhim two good motions-Red-ness down the right side of theface less—Pain in the head di-minished, and the patient ap-pears quite relieved. Tonguewhite, edges red—Thirsty-Pulse 60, full-Took some breadand milk this morning, whichis the only sustenance he hastaken since the accident.

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Feb. 15th, 3, p. m. Passed a

good, night—Bowels not opensince yesterday-Pulse 76, full-Slight pain, on pressure, in theleft hypochondriac region-Wound dressed this morning,united in some parts-Poultice ’applied to it on account of

slight swelling- in that part-Has just taken five grains ofextract of colocynth and threeof calomel.

Feb. 16th. Feels much bet-ter-Bowels opened twice lastnight and twice this morning. ’,

Feb. 17th. Continues better- ,Wound looks healthy-The in-cision that was made in order toexpose the wound is nearly ’,healed-The one infiicted bythe horse is not tinited- --A thindischarge comes from the part.

Feb. 21st. The boy is goingon very well, and in a fair wayof recovery.

The following clinical obser-vations in reference to the abovecase, were delivered by Mr.TRAVERS, in the operating’ thea-tre, on Thursday last.

GENTLEMEN,—This case does notfurnish much matter for comment.All injuries of the head. however, in asurgical point of view are of great im-portance, and it is scarcely possiblethat any case of the kind can happenwithout proving of more or less valueto the practical surgeon.When this boy was first seen, the

symptoms were of a mixed kind, thatis,they developed the combined injuriesof compression and concussion ; thts is

by no means uncommon, indeed in in-juries of the head the symptoms ofconcussion and compression are muchmore frequently blended than other-wise. Authors, ’tis true, in treatingof these affections, have laid down pre-c’se extremes of - appearances, andsymptoms marking the two inj uries astotally distinct, - and describing thesymptoms with peculiar nicety, as

applicable to each. With me, however,it is a question whether, in either case,the symptoms are ever so pure andsimple as have been described. Theyare always, in my opinion, more or lessintermixed. I never saw a case ofconcussion that did not present someof the symptoms characteristic of com-pression, and vi-ce versa. In the in-stance before us the pupils were notextremely dilated. He was sensibleif spoken to sharply, and would answerany question put to him. He appearedhowever to speak with reluctance, andseemed desirous to remain undisturbed.He ejected his food, and -this symp-tom belongs to concussion as well as tocompression; it is quite as common

with the one as with the other. Whilethey were carrying this lad from theward up the stairs to the operatingtheatie, the bandage slipped from hisarm, where he had been bled, and he lostin consequence a considerable quantityof blood before it was discovered, pro-bably -twelve ounces. This circum-stance unquestionably proved of greatservice to him, as the coma immedi-ately became sensibly less, and he wasperfectly conscious of all that waspassing. I believe the furtnei loss ofblood occasioned by the division of thescalp had a beneficial effect. I mayhere remark that I have several timesbeen called to persons suffering underaimilar injuries, in whom I have foundcoma existing to a great degree, ac-companied with considerable tumoursunder the scaln. These tumours havea delusive feet; this, however, is notof much consequence, as there can beno difficulty in determining the.proper ’course to be pursued in such cases.You must make incisions into’ thescalp, covering these swellings, whichwill often be followed by considerabledischarges of blood, and likewise by allinstantaneous remission of’ the coma-tose symptoms. This fact may be thus:explained-a fissure occurs in the bane- -some of the blood vessels becomelacerated, the bloud escapes, collectsunder the tendon of the occipito-fron-talis,passes through the fracture, pressesupon the dura mater, and coma is pro-duced; you make an opening in thescalp, the blood is discharged, pressureupon the dura mater is thereby takenoff’,and the coma disappears. In all casesof injuries of the head where the symp-toms of compression come on imme-diately, it is right to ascertain; by a

262

care-ful examination of the woundedpart; the extent of the injury. Shouldthere, be an opening in, the scalp, if

necessary, it must be enlarged, and. ifthe scalp which covers the fractureremain _entire, it should be divided forthe purpose of discovering the charac-ter of the injury. This practice has beenobjected to by some surgeons ; but itis folly to reason against a method oftreatment which may be productive ofthe best possible consequences, andwhich at. the same time can never giverise to the slightest hazard or incon-venience to the patient. You dilatethe wound iri one case, and rjaake, anopening through the scalp in the other.As I have just stated., when the symp-tqms of compression are caused by thebibodi collecting under the occipito-li7,ontalis, then passing through the fis-sltre, occasioning pressure upon the duramater, an incision into the scalp,. byslowing the blood to escape, will oftenbe speedily followed by the absence ofevery symptom of coma. On the otherhand, if the fracture be confined to theexternal table of the cranium,, still theloss of blood occasioned by the incisionwill prove of fiervice, as a preventiveof *’ inflammation.- After the divi-sion in .such, cases nothing more thansimple medical treatment will be re-

guisite, as in the instance of this boy.When I saw hini on the following day,still haying the symptoms which havebeen detailed to you in the report ofthe case, and being satisfied that no-thing more could be done for him inthe operating way, I ordered the pur-gative medicine, and cathartic clyster,,for the purpose of restoring the se-

cretions, upon ’the reproduction ofwhich, the unfavourable symptoms im-mediately vanished. The purgativetherefore was attended with the best Ipossible effects.When you cut down upon the cra-

nium, in cases of compression, for the

purpose of ascertaining the extent offracture, you should divide the scalpfor a quarter or half an inch ‘beyondthe fracture ;. for it often happens thatthe fissure will cease to be observablefor a short distance when, upon tracinga little farther, you suddenly burst

upon another fracture, much worsethan the one to which your attentionwas at first directed. Sometimesfractures of the cranium are so exten-sive, that if aU the loose pieces of bone

were to be removed half the brain wouldbe exposed. In manv fractures of thahead, accompanied wit depression, therewill be no necessity to apply the’ tre=phine, as by making a fulcrum of thesound bone you can- raise the depressedportion by means of the elevator. Thispractice is now .adopted by the bestsurgeons, and the trephine is hot at’present employed more frequently.than as one to twenty when comparedwith our ancestots. Some surgeons ofeminence in this town, in cases of n’ac-ture with depressed bone, recommendthe operation of elevation, to be de-layed, unless the symptoms ofcompres-sion are very urgent, and require itsimmediate adoption. This I considera very fatal error, and strongly adviseyou to avoid it. I hold it ,right in,,allcases of fracture of the cranium wheresymptoms of pressure are presentthat the causes of such pressure shouldbe immediately removed.—Trepan one

person directly after the injury-andin another delay the operation threedays-which of the two has the bestchance of recovery-which is the leastliable to danger? Why unquestionablythe first, for in this case there is anabsence of inflammation, while in theother you defer the operation untilafter it has occurred. I consider thedanger chiefly to arise from the prone-ness to meningeal inflammation aris-

ing from the irritation produced by thedepressed bone. Therefore say,when pressure, upon the dura materexists, the patient has no chance, atleast no fair chance of recovery ifyou delay the operation so as to allowinflammation, of the membranes -tocome on. In cases then of fractureof the skull, accompanied with symp-toms of compression, operate, sui- le

chanxp, whereby you make the opera-tion and injury one. I remember twoparallel cases in Guy’s, which weretreated according to the two modes Ihave been speaking of, a more completeparallel in point of’ age, symptoms,and injury, could not have been metwith ) one of these patients was ope-rated on immediately after the accident;in the other the operation -was post.poned to the fffth day ; the first patientdid extremely well, and recoveredwithout an unfavourable symptom; -,the second died at the end of thirty-six hours after the operation. I deemit unnecessary to say more to you onthis subject, , ... .

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A schirrous breast, and a. smalltumour from the inner angle ofthe eye, were- removed to-day(Feb. 20th), by Mr. TRAVERS.

The accidents admitted thisweek, are a fracture of the hu-merus, of the ribs, a lacerationof the scalp ; an - injury to theupper arm, from the dischargeof a musket, which contained

powdex and wadding; -and ajammed finger.

’ ’ ,

,

MIDDLESEX HOSPITAL.

Continuation of the Case ofWM. ROSE.

Feb. 12. The young man ope-rated upon by Mr. BELL, andwhose case was described in ourlast week’s report, has had nounfavourable symptoms since.--.The stump has been repeatedlydressed. Suppuration and gran-ulations of healthy aspect andsanative tendency may at presentbe noticed. The irritability ofthe stump has, at the same time,wholly subsided. He has taken nomedicine since our last, excepta dose of house-medicine to eva-cuate the bowels.—His sleep atpresent is natural and refreshingwithout the assistance of an

opiate. Bowels generally regu-,lar, tongue clean, and skinabout the natural temperature,and moist. His diet consists ofmeat, rice pudding’, and milk,with the allowance of a littlebeer. Pulse to-day about, 84,and tolerably full. ’

A nsevus of considerable pro-minence and extent, was re-

moved from the nose of a boy,on Wednesday last, by Mr.

BELL. The hemorrhage, whichwas considerable, was subduedby the actual cautery, with thesubsequent assistance of thearg-enti iiitras, and the tinct:ferri muriati.—N.B. Although.we have called this excrescencea naevus, it did not appear tous to possess any of the -ex-ternal appearances, by whichthese’ elevations, or prominences,are usually characterised, nordid It accord with any thing Mr.JOHN BELL has said in his" Principles," about Aneurism.by Anastomosis. Nor, ’indeed,is there any better reason forsupposing it to have been,. ofscrofutous origin. - It appearsto us to have been an excres-cence entirely, sui generis, about

‘

which nosologists and practicalwriters have said but little, atany rate, as far as our researcheshave been carried. We shallprobably return to the subjecton some future opportunity.,

In the case of MARTHA HOL-LIWELL, all we have to remarkmay be briefly expressed as fol-lows :-Appetite good—Rowelsregular, but occasionally requir-ing a Colocynth pill.—Woundnearly healed up by granulations.- - Quantity of pus discharged =daily, about a table-spoonful,or perhaps a trifle more.—Pulseto-day 76.—Tongue clean, andskin healthy.-Is capable of-ac- .complishing a trifling degree of .motion in the leg and foot ofthe affected limb, which, how--’ever,, still’ remains about 3inches shorter than the other.-Me at diet, with wine,- &e. as

before. , ,

Feb. 12th. Among- the acci-