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BARTHOLOMEW'S HOSPITAL

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torious class of men, the surgeon-apotheca-ries or general practitioners, and yet eventhese have only the sale of their inedicinesfor their support, as the existing law allowsthem no remuneration for professional la-bout or waste of time. Why should medi-cal men endanger their health and lives, andthose of their families, gratuitously, whensociety exempts the other learned profes-sions from such gratuitous exertions ? Ano-ther defect in our profession is, that the

duly qualified physicians and surgeons are ina great measure deprived of their rights, bybeing precluded from attending the majorityof the sick, which arises both from the exor-bitance of their fees, and from the infringe-ment of the general practitioners, chemistsand druggist. Thus, in Ireland, nearly thewhole of the practice of medicine and sur-gery is in the hands of the apothecaries,who are not obliged to attend any lectureson medicine or surgery, but who, after havingserved an apprenticeship behind a counter inhat country, and never having seen the ilite ..ripr of the human body, or perused a book butthe Pharrnacopoeia, prescribe in all cases

with much greater confidence, than the mostscientific and experienced physicians ; theyattend for several days, until death staresthem, and then they call most lustily forproper assistance. Another anomaly in the

’ profession in that country is, that the

county infirmaries, and most of the feverhospitals and dispensaries are attended bysurgeons, and have no physicians; and suchsurgeons must be members of the Iri Col-lege, for those of the English, Scotch, orFrench oolleges, who are a most numerousbody in Ireland, are inadmissible. ThoughEnglish surgeons may attend the large hos-pitals at this side of the water, they are saidto lose all " sound chirurgical knowledge,"when in Ireland, " for the members of theIrish College of Surgeons must not consultwith English or foreign surgeons, on pain of expulsion." By laws of the College of Sur-geons of Ireland, 1815, p. 8, " Nor would-they meet Sir A. Cooper, your irritablefriend Mr. Abernethy," * nor Barons Larreyand Dupuytren, if they resided in Dublin,in consultation. Dispensaries, goals, andpublic institutions to which medical officersare attached in that country, are nearly all

jobs, and he who has most interest, howeverunqualified, will be appointed.

HYGEIAPHILOS.

* Dr. Grattan’s Remarks on the MedicalProfession in Ireland, London Med. Jour.,1821, Vol. XLV. page 183,

HOSPITAL REPORTS,

BARTHOLOMEW’S HOSPITAL

TWO CASES OF BETINITIS.ætat. 22, was admitted into

Henry’s Ward, on the 30th of July, withamaurosis of the right eye. On the even.

ing of the 29th, he retired to bed in per.fect health. About 3 o’clock in the man.

ing of the 30th, he perceived the sight ofthe right eye was considerably impairei,and when he arose in the morning, it trvnearly lost ; in consequence he went to theMoorfield’s Ophthalmic institution, whereMr. Lawrence saw him, and admitted himto this hospital. At the time of his admis.sion, although sight was not completely.lost,yet he could not distinguish objects; hawas merely able to perceive light from datk.ness ; the conjunctiva was inflamed; the

pupil in the same state as that of the soundeye ; he had pain in the head and eye; Littongue was clean, and pulse 84.

Mr. Lawrence ordered him to be bled addeliquium, and to take immediately, x. grsof jalap, and three of calomel, and after,wards to take two grains of calomel,and one third of a grain of opium, everjsix hours ; xxx. of blood were takeafrom him before fainting was produced. Onthe following morning, 31st, xvi. more

were abstracted from the temples, by cup.ping. By these means perfect vision wasrestored.

August 1. The man could read thesmallest print; Mr. Lawrence absent)that the present was a case which exempli-fied, in a very complete manner, the patho-logy ofamaurosis, and at the same time thecontrol which we have over the disease ian early stage, by the free use of the lancet,he said that the power of the lancet in over,

coming the disease, was considerably les-sened when it had continued some days.

Another case of a similar nature occur-red at the same time. On the 1st of AugEliza Radley, a girl of 16, was admittedinto Elizabeth’s Ward, with amanrosis ofthe left eye, but more confirmed than in theformer case. There was a slight redness ofthe conjunctiva, the pupil in tle same statewith the sound eye the loss of vision wasnearly complete in the aflected eye.

She had received a blow on it about tendays before, but had not experienced anyinconvenience until four days before her

ttdmission, when vision had been complete))lost. Mr. Lawrence ordered her to losexvi. of blood from the temples, by cuppir,to take immediately ten grains of jalap, and

Page 2: BARTHOLOMEW'S HOSPITAL

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two of calomel, and afterwards to repeat two °

grains of calamel, and one third of a grainof opium every six hours.The following day her- bowels not being

open, an enema was administered, which ‘had the desired effect. I.On the 3d she had in a great measure re

.gained vision, and at this time, the 6th, isable to perceive the most minute objects ;the iris is obedient to the stimulus of light;she took the .calomel and opium up to the5th, but without-affecting her mouth.

She was discharged, cured, on the 7th.

SUDDEN DEATH IN A CASE OF COMPOUND

FRACTURE, FROM ANASARCOUS SEROUS

COLLECTION IN THE BRAIN.

Joseph Keen, ætat. 64, was admitted intoRahere’s Ward, with compound fracture ofthe leg. The wheel of a coach had passedover both legs, and fractured one in thelower third of ’the limb. The tibia wasbroken very obliquely, and a small open-ing made in the skin by the inferior

extremity of tie upper fragment, thecuticle abraded, and the skin severelybruised in two places, about the size of ashilling. The patient was laid on his back,the limb (of which the calf was very large,)placed on a pillow, straight, in a fracturebox, supported laterally by pads; and theexternal wound dressed with lint and ad-hesive plaster. The fracture of the tibia

being very oblique, the bone could not bevery accurately adjusted; the deviation,however, from the natural line, was trifling.The sharp end of the lower fragment was alittle higher than it ought to have been, andpressed against the skin, threatening to

push its way through.October 29. By moving in the night, the

patient had again displaced the broken ends;a pair of splints was added to the formerapparatus to preserve the fracture steady.

°

November 23. The case has proceededwithout a single unfavourable symptom,local or general; the external wound healedby the first intention ; the two bruised por-tions of skin sloughed and separated withoutinflammation of the surrounding parts. The

patient has had a good appetite ; clean

tongue ; and rested well, requiring no othermedicine than an occasional anerient. The

Jpg has been kept in the fracture box withthe splints.December 2. Union of the tibia apparently

firm; the limb to be removed from the frac-ture box, and rolled.

14. On accurate examination, it appearsthe broken bones are not sufficiently unitedto preclude all motion ; the limb to be placedon its sides,and to be confined by splints.

16. Being generally swollen and uneasy,it was placed in the fracture box, with

lateral splints, from which it was removedat the end of six weeks; when the unionseemed quite fu-m. In the beginning of

February he got up daily ; began to moveabout with the aid of crutches, his healthappearing excellent, as it had been through-out. On the 14th of February, his leg andthigh were swollen considerably, withoutredness or heat ; the tumefaction apparentlycaused by rubbing the limb with soap lini-ment, was firm and general. He was di-rected to go to bed, and keep clothes con- stantly damp with saturnine lotio,ns to thelimb, and to take an aperient. The limbbecame less, and he went to bed in hisusual good health, on the 13th. In the

middle of the night lie called for- the nurse,but expired before she could get to him.

Post-mortem examination.The body was very fat, the adipose mem-

brane covering tlie abdominal muscles beingabout two inches in depth. The veins ofthe lungs and of the body generally, werefull of blood; there was no disease, eitherin the thoracic or abdominal cavities, ex-cept old adhesions on one side of the chest.

The.arachnoid coat was thickened, opaque,and tough over the whole convexities of thecerebral hemisplaeres, and the cellular tex-ture of the pia mater loaded with serum-On taking off the membranes, the surface ofthe brain was drenched with water, and alarge quantity ran down.The cerebral convolutions were separated

by considerable intervals, which had beenoccupid by the anasarcous pia mater. Eachventricle contained about two ounces of theclearest and most transparent fluid ; this in-creased secretion had raised the fornix, soas to make the communication between thetwo lateral ventricles direct. All the ves-sels of the brain were turgid, and the bloodypoints innumerous and large, wherever the .

cerebral substance was cut into. The pa-tient had complained of no pain, nor had heexhibited any symptom of cerebral dis-

turbance : it must, therefore, be observed,that the above described change in the ves-sels and membranes, and effusion into theventricles, had taken place very slowly, andthe continued enjoyment of good healthmust be considered as anomalous in thisease. The patient, indeed, exhibited a dul-ness of apprehension, and general sluggish-ness of intellect, which were supposed uatu-tural to him, but which probably arose

from the morbid changes in the brain.After all, the suddeness of death is not ac-counted for ; he must have expired almost

instantaneously ; yet no change could be. discovered in the brain, capable of causing,such an event. The tibia was not com-

pletely consolidated, although the union was, sufficiently perfect for all the uses of sup-i port and motion.