641

tinct. of opium were given, which procured’ him rest. Feels better than yesterday; appetite seems to mend; the slough sepa- irated to-day, and granulations are formed ibeneath ; the dressings reapplied. Yoiiei- lbj. Pulse easily compressible.

31. Pulse good; tongue clean; bowelsnot open; skin moist; slept well, andfeels himself stronger. Continue as be-fore.

Aug. 1. Improving, but pulse not sogood, being weaker; tongue moist. The wound discharges a quantity of well-formed pus. The dressings to be removedevery day. Continue as before.

2. Better; pulse good; tongue clean;skin moist; bowels have not been purgedsince the action of the castor oil. Acarhartic draught was ordered, as the oilproduced sickness ; the dose to be repeatedin the course of the afternoon, if requisite.Continue.

3. The draught was repeated, whichacted freely on the bowels: the dropswere not given, as the man was in a soundsleep, which continued till four o’clock ;discharge rather increased; granulationslook well; pulse soft; complains of painunder the elbow, which was removed byplacing a pad beneath the hand; tonguefurred and brown ; appetite much thesame. Opium to be omitted, as he sleptwithout it the preceding night. Bowelsnot open.

4. Going on well in every respect; feelsquite easy; slept without the opium ;bowels confined. Continue the mixture,wine, and porter.

5. Continues much the same; did notsleep so well as on the night before ; pulse63, and soft; skin moist; bowels not re-lieved. Continue.

6. Splints removed this morning, fromwhich he felt exhausted; more restlessduring the night; pulse weak; tonguefnrred; bowels have been opened; swell-ing decreased ; arm more sensitive, theleast motion causing pain. Continue themedicine, wine, and porter.

INFLAMMATION OF THE ELBOW-JOINT.

William Johnson, setat. 20, tailor, wa;-admitted July 4th, into Mellish’s Ward, under the care of Sir WILLiAM BLIZARD. IAbout four days ago he felt slight pain in the elbow, which gradually increased. Hedoes not remember having injured it inany way. On his admission the elbowpresented the following appearances :-Considerable swelling; redness of the in-teguments, with increase of heat; effusioninto the cavity; extreme pain. He hashad no rest for the last two nights.Twelve leeches to be applied round the

joint; sour wash; a dose of house medicine;the arm placed in a bent position on apillow.

7. Better; pain diminished; bowelsopened by the purgative medicine. Re-peat the lotion.

8. Not so well; the redness of skin ex-tending ; pain more acute. Twelve leechesto be applied every other day. Lotioncontinued.

10. Worse; pain increased. The leechesto he applied every day: lotion and housemixture to be repeated.

13. Continues much the same; painslightly diminished. Continue the mix-ture, lotion, and leeches. The limb to besupported on a splint.

11. Complains of great pain shooting upinto the axilla, likewise down to the wrist;slight inflammatory fever ; pulse full andhard ; tongue dry; bowels regular. To behIed to sixteen ounces; the leeches andlotion continued. Saline antimonial mixtureto be taken three times a day; Plummer’spIli, five grains, every night.

19. Feels greatly relieved by the ab-straction of blood ; swelling rather dimi-nished ; less pain ; sleeps badly; tongueslightly furred; pulse soft; bowels open.

27. Improving gradually. A blister tobe applied to each side of the joint. Con-tinue as before.

31. Much better in every respect; thesour application applied over the blisteredsurface; bowels regular; no pain in theelbow.

Aug. 5. Continues to improve.

WESTMINSTER HOSPITAL.

DISLOCATION OF THE FEMUR.

JULY 14. Henry Atkins, a lad, ten yearsof age, having been admitted yester-’lay into the Percy Ward with supposeddislocation of the hip, an examination wasmade by Mr. Guthrie and his colleaguesto-day, and the majority came to the con-clusion, that it was an extremely well-marked case of luxation on the dorsuma.cetabuli. Mr. Lynn, we were given tounderstand, dissented from the generalopinion, but we were not early enough tohear the grounds of this difference. Mr.Guthrie being thus upheld, proceededforthwith to reduce the dislocation, andhad the boy brought into the theatre for

the purpose of having the pulleys moreeffectively applied. Extension and coun.

ter-extension were made as usual, and ina few minutes the head of the bone was

t audibly and visibly restored to its place.Some of the critics were not satisfied with. the manner of the reduction, and pro-; nounced it to be clumsy and unscientific,

642

but the principles laid down in the bookswere attended to. After the boy wastaken away, Mr. Guthrie made the follow-ing remarks for the benefit of the tyros." Gentlemen, you have had an opportunityto-day of seeing an exceedingly well-marked case of dislocation of the femur onthe back of the ileum, and one reducedwith remarkable facility. My experiencedcolleague Mr. Lynn suspected there wasfracture, upon what ground I do not

know, for to me the case presented all thediagnostic marks ofluxation. The lengthof the affected limb was curtailed aboutan inch, which effect is produced by thealtered position of the head of the bone;it was inverted in consequence, likewise,of the situation of the ball of the femur,the external rotators having been lace-rated, or extended to such a degree thattheir power was paralysed. The back ofthe great-toe was resting in the oppositefossa. The limb could not be drawndown to its due length, nor rotated in theway that takes place in fracture of thecervix femoris. The limb too was inverted,whereas in fracture (in the great major-ity of instances) it is everted, owing to apeculiarity in the insertion of the gluteamuscles. The head of the bone was dis-

tinguishable with ease. If there be butlittle or no mobility of the limb, with rigidinversion and decurtation, you may restpretty confident that luxation exists, pro-vided there he no contrarv indication inthe external contour of the joint. In thecase before us, no crepitus could be distin-guished either by the hand or ear."

26. The boy was placed on his back inbed, and a strong flannel roller appliedround the hips. The patient has done

very well, being very tractable. This daythe two limbs are exactly of the samelength, and in the natural form and po-sition. Mr. Guthrie has improved hisdiet, and now allows him to walk a littleabout the ward.

LUMBAR ABSCESS.—NOTIONS OF ABER-

NETHY AND BEDDOES.

17th July. All the surgeons attendedto-day, and the attention of the visitorswas drawn to a number of scrofulouscases. In John’s ward Mr. WHITE openeda lumbar abscess (case of John Snewingadmitted 28th May) which pointed justbelow Poupart’s ligament of the left side.The valvular incision was made. and

forty-eight ounces of good pus flowed out.It was observed, that " Dr. BEDDOES

and Mr. ABERNETHY both flattered them-selves they had devised a cure for thisformidable malady, lumbar abscess. Dr.BEDDOES’s panacea was the inhalation of

hydrogen gas, and Mr. ABERNETHY pro.posed to dry up the abscess by the gradualevacuation of the matter, taking especialcare to prevent the admission of the air,by making a valvular incision. ’Havingmade your incision,’ ABERNETH used tosay, I let the pus flow in a good stream,and when you perceive it slacken, pressthe lips of the incision together, thusclosing the mouth of the apostematous sacbefore all the liquid contents shall haveescaped, and consequently before any aircan have entered."’ Mr. WHITE said, " Undoubtedly several

instances had occurred, in which, afterthe admission of atmospheric air, inflam.mation of the sac had taken place, andspeedy dissolution had been the result;but there were nearly as many examplesin which no such result had followed fromthat circumstance. There was once a

young lady of fortune, who put herselfunder the care of Mr. ABERNETHY, forthis disease. It had existed a long time,and pointed in one of the thighs. Heopened the sac according to his well.known plan; repeated punctures were

made with the utmost care, and of coursethe digestive organs were not neglectedby him. Under this system the younglady improved rapidly, and left Londonfor Cheltenham. Whilst there she metDr. BEDDOES, who took her under hiscare, and subjected her daily to the in.halation of hydrogen gas into the lungs.In consequence of, or in spite of, this pro-cess, she continued to amend, and her

I health became quite re-established. Dr.BEDDOES published a flaming account ofthis case, and claimed the merit of thecure, without mentioning a syllable of thesurgical part of the treatment. Thisexcited the indignation of ABERNETHY,who, in his lectures, earnestly and hii-morously set forth the claims of the val-vular incision to the honour of this cure.The merit of the recovery is probably dueto the goodness of the young lady’s consti-tution, and she would very likely havebecome well, whether the systems of thesephilosophers had been adopted or not.

The valvular form of the incision is a pre-caution, which, having a show of reason inits favour, may as well be taken. As tothe inhalation treatment, it is a naturaloffspring of such a prurient fancy as thatof Dr. BEDDOES, and worthy of a place inthe erudite system of the Harley-streetquack."

.

Mr. ’WHITE afterwards stated his belief,that this disease originates in the inter-vertebral substances of the lumbar ver-tebræ.- Snewing’s general health has been im.proved since the evacuation of the pus;

643

about a pint of it is discharged daily, itscharacter is good, not exhibiting theslightest putrescency, and the sac hasnever given him the least pain or uneasi-ness.

SCROFULA.

In Mark’s ward, Mr. LYNN had a caseof strumous disease of the joints of the

right-hand. He amputated the index-

finger, and the wound appeared to granu-late kindly. The next finger had its se-cond joint very much enlarged and sup-purating, the structure of the jointand the adjacent parts having entirelydegenerated. One of the pupils ob-served to Mr. LYNN, that if he intendedto cure this patient, he ought to give himthe prescription of Nicodemus, and orderhim to be born again, or, in default of that,to supply him with the vis medicatrix ofPrometheus.Mr. LYNN replied, " I don’t think that

attention to the digestive organs and mypill* have done much, but I don’t despairof their being equal to the cure of this

young man. You see. Sir, it is a plaincase of scrofula, and has been producedchiefly by hard living. The fellow is a

handicraftsman, and has been in the habitof working in a cold damp shop, and haslived on inferior and ill-cooked food. Thiswretched climate of ours is the fruitful

parent of scrofula, and this fertility ismuch promoted by the improvidence andintemperance of the people. In warmclimates struma is a much less commondisease than it is here, and in India thereis no proof of its ever having been metwith."At this moment, Sir ANTHONY CAR-

LISLE observing Mr. LYNN earnestly en-gaged in conversation at the bed of thispatient, and knowing the ineisorial pro-pensities of his colleague, approached, ex-claiming " Ah, my old friend, what ! an-gling for an operation, eh?"

" Oh no," replied Mr. LYNN, "we havehad a bit in that way already; we wantyour opinion as to the possibility of savingthis next middle-finger." Sir ANTHONY,after an examination, said, " I think thefinger is lost, nothing but a miracle cansave it, and we do not commonly haverecourse to miracles in our profession.Johanna Southcott too is dead, PrinceHohenlohe is not to be found, and theKing’s touch has lost its virtue in these

Mr. LYNK’S "pills" are very popularin Westminster, and generally sold as

nostrums by the chemists. The recipe isthis: Extr. Coloc. Comp. gr. ii; Pil. RuJi gr.ii; Calomel gr. i. Fiat pilula.

radical days ; consequently I see no re-medy but amputation of the finger. Ourold friend here has had much more expe-rience than any of us, and opines favour-ably of taking it off; and I have no doubt,my man, this is the best measure that canbe taken in your case. Gentlemen, scro-fula is a disease that chiefly arises fromphysical causes; depraved moral habitspredispose to its formation, and certainconstitutions perhaps are more susceptiblethan others ; but I entirely deny its pos-sessing any hereditary property, and Ibelieve that, taken at a sufficiently earlystage, it may be overcome by warm dryclothing, good plain nutritious diet, regu-lar habits of labour and rest, and the ge-neral domination of reason over appetite."

HÆMATURIA.

The case of John Warren (hemorrhagefrom the bladder), related in No. 515 ofTHE LANCET, was alluded to. It appearsWarren has, since that report, been dis-charged, quite well, having been steadilytreated by Mr. H. FINCH, according tothe plan prescribed by Mr. GUTHRIE.Mr. LYNN took occasion to observe, thathe differed entirely from the opinionsascribed by THE LANCET reporter to Mr.GUTIIRIE and Mr. WHITE. He did notbelieve that in hæmaturia the blood evercoagulated.

A MISCELLANY.

July 21. Sir ANTHONY CARLISLE vi-sited his cases to-day, which were princi-pally of a medico-chirurgical character.Sir ANTHONY observed to the pupilsaround him, "It is much to be lamentedthat physicians are so entirely empiricalin their practice. Dang it, I never for thelife of me could discover any rational

principle in a physician’s treatment of acase, and whenever I see one of them

feeling a pulse, I cannot help calling tomind the well-known epitaph, to be seenin every graveyard :-

’ Afflictions sote long time I bore,Physicians once I tried,

Of peace or ea-e 1 had no more,They * left me when I died.’

The poor defunct found that ’ once’ and’ for ever’ were synonymous in the voca-

bulary of a physician. In the days of yorethev made some attempts to theorise; wehad the mechanical physicians, who treateddiseases like so many carpenters ; we hadthe advocates for the cure by signs, andthe Stahleans, who considered everyfunction to have a distinct soul. Now

amongst these we find some attempts atratiocination, but amongst our contempo-

* The Doctors.

644

raries reason is dormant, or, as JohnHunter woul t say, ’ if they attempt toreason at all, they are sure to reason

wrong.’ Their application of remedies islike throwing mud against a wall ; if youthrow a good deal, some of it will stick.They have ascribed to me a saying of Dr.Haslam, that ’ Medicine was « setence found-ed on coujecture, and irnltroued hy murder.’Now there is some truth as well as wit inthis assertion, but it is much too epigram-matic for me. That Haslam is a man offirst-rate talents, though a queer dog.There is certainly a good deal of guess-work in medicine; hut if I were compelledto adopt any hypothesis, I should preferthat of the chemists, or alchemists, whichascribes diseases to a prevailing peccantacid. Forsooth you will find a good dealin the economy of the human frame thatmay be elucidated by a reference to animalchemistry. In erysipelas, for example, Ihave long been persuaded that there is aredundant acid, and my alkaline treatment is known to be the most successfulthat has been adopted."The learned knight prescribed soda

almost universally for the cases. It is butjustice to bear witness that Sir ANTHONYhas indeed been very successful m themanagement of erysipelas, and the mix-ture, which in the hospital is called sack,from the initials of the author Sir A. C. Knt.,is a most prompt, efficient, and yet safeand mild, purge. The receipt is as fol-lows :-Take of I

Jalap in powder, a drachm,Supertartrate f Soda, two scruplesSubearbonate of Soda, of each.luf’osiotc of Senna, six ounces. Mix. Twoounces for a dose to an adult. In Itwo hours its effects take place; and iit is known to be so certain that the

Knight’s colleagues have generallyadopted it.

VETERINARY MEDICINE.

PROFESSSOR YOUATT’S LECTURES.

IN the number which concluded THELANCET for the years 1831-2, we alludedto the impossibility of completing the pub -lication of Professor YouATT’s Lecturesin the wo volumes of that period. Thecause of the non-fulfillment of our pro-mise was kindly explained, in a note tothe editor, by Professor YOUATT himselfwherein he remarked,-

" Neither you nor I could foresee the" almost constant ill-health which pre-

49 vented the punctual transmission of the

lectures." Mr. YOUATT then stated," That if a report of the remaining lec-" tures of the session, including the Uia." enses of the Nervous Systern, and particu-" larly the Nature aIi’d Symptnms of Rabies" in Brutes, and also the Analomy and Pn." thology of the DIgestive System, would be" considered interesting to the readers of"THE LANCET, they should be regularly" forthcoming."This offer we readily embraced, and we

promised, forthwith, to publish the addi.tional lectures on the important subjectsnamed, in the form of Supplements, andwe declared our intention in the followingpassage :-

" This course is the fairest to adoptwith respect to our readers; because thosegentlemen who may have commencedtaking THE LANCET for the purpose ofobtaining possession of Mr. YOUATT’s dis.courses, will now be enabled, if theyshould think proper, to discontinue the

journal, and yet procure the lectures iri

Supplements, until the whole are com-pleted." " The first supplement will beready towards the end of November, andas we apprehend that those readers whoare in possession of the first part of thecourse will wisn for the remainder, thisfirst supplement will be annexed to thetrurn.ber of THE LANCET, unless there be a specifierequest to the contrary."

Unfortunately, the continuance of thesevere illness ot Mr. YOUATT has pre.vented us from continuing the publicationof his lectures until the present moment.However deeply, therefore, we may haveregretted the delay, and the consequentdisappointment of our readers, the post-ponement was entirely unavoidable.

Medicus, of Nottingham. whose letter onthe instruments" was alluded two by us last week,has not ve. favoured us with the coufidential re-

fere ce tu etab:is his identity, whtfh thf c reum.stancs of tlie case dememi, fur our own sat!sf, c-

tion, helure his s alpmpnt IS mad,- public.

i The letter of .4. B., respecting the Uni.ve’!-it) o’ t Andrew’s, was mter ded for publica-tion. hut the virtual Mbandnomcnt of the Bill inquestion renders that step cesary. Of coursethe general inqury which is to he insti’nted nextsession, will luliy embiace the claims of the iieg.tcc’cd University.We know nothing more of the Society

than des Inve tor but we bel eve that it is

not a b’a ch of tte YV. G. D Socte’y-We havenot room this week to nply to any other corre-spondeu.