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:CCCE3SFBL TREATMENT OF AGUE BY THE IiEXHIBITION OF A LARGE DOSE OF SUI.-PHATE OF QUININE DURING THE INTER-

MISSION. IOn two former occasions, we have noticedthe successful treatment of intermittents atthis Hospital : the season having been un-usually rife with ague. In the first instance,we remarked on the success attendant uponthe exhibition of sulphate of quinine, indoses of two or three grains or more, givenevery four hours, during the absence of theparoxysm. On the second occasion, somecases were related, illustrative of the ef-

ficacy of sulphate of quinine exhibited in adose of ten grains, at a short time previouslyto the accession of the paroxysm.We have now to sneak of a third mode

of exhibiting the quinine, namely, by theadministration of one full dose (10 grains)during the absence of the paroxysm. Thislatter plan of treatment, according to Dr.Elliotson’s experience, is pre-eminentlyin successful ; his opinion of the diffe-rent modes of exhibiting the quinine, whichwe have mentioned, is, that they standin relation to each other as the degreesof comparison—good, better, and best. In

going round the wards on Tuesday last, Dr.Elliotson pointed out upwards of a dozencases of ague, which had been cured by onedose of the quinine, given at the interval ofa few hours from the cold stage. The agueswere of different types, but for the greaterpart of the tertian. kind. There was onecase of double tertian.

GUY’S HOSPITAL.

CASE OF COMPOUND FRACTURE OF THE SKULL,WITHOUT DEPRESSION.

TIIOaLnsPOLLARD, 15 years of age, wasadmitted into Accident Ward, under thecare of Air. Key, on the morning of the2d of June, having received an injury tothe head. The accident occurred a short

time previously to admission, and was oc-casioned by his foot slipping from a piank,and falling with his head against the edgeof a large boiler, belonging to a steam en-gine. lie was stunned by the blow, butwas not rendered totally insensible. Onexamining the head, an oblique wound ofthe scalp was discovered on the upper andback part of the right parietal bone ; itwas of about two inches in extent, and waswhat might be termed a clean cut; therehad not been much bleeding from the wound.A probe being employed, in order to ascer-tain whether any injury had been done to

the bone, a crack or fissure was readily de-tected, pursuing nearly the same obliquecourse as the wound, and being almost ofequal length ; there was no depression ofbone.’*

The head being first shaved, the woundwas dressed simply with strips of adhesiveplaster and a piece of lint, it being theopinion of Mr. Callaway, who saw the case,that union would take place by the first in-tention. There were not, at the time ofadmission, any marked symptoms indicativeof injury done to the head ; the boy waspale and the pulse was feeble, but no fur-ther symptom existed.

In the afternoon some degree of re-actionhad taken place ; the face was flushed, thepulse was somewhat sharp, the skin was hot,and the boy complained of pain in the head,with a sense of constriction ; the pupils weredilated, and not readily obedient to light. Afew ounces of blood were taken from thearm, and some pills exhibited, consisting ofcolocynth and calomel.On the following morning (23d) the pulse

had become soft and easily compressible ;the bowels freely relieved, and the head-ache subsided in a great degree ; the pu-pils, however, were more dilated than na-tural. Mr. Key directed the head to be

kept cool, and a dose of saline mixture, con-taining a fourth of a grain of tartar emetic,to be given every four hours.

24, 26. Free from any unfavourablesymptoms; the wound of the scalp has corn*pletely healed.

’

July 1. Continues well.

CASE OF EXTENSIVE LACERATION OF THE

BRAIN, WITH EFFUSION OF BLOOD INTOITS SUBSTANCE.

A poor old woman was brought to the Hos-pital on the 8/th of June, about mid-day,having been picked up in the middle of thestreet in a state of insensibility ; it was sup-posed that she bad been knocked down bysome vehicle, but no distinct account couldbe obtained from the persons who broughther to the hospital.

She was completely comatose, and couldnot by any means be roused ; the pulse wasof a labouring kind, and the skin was cold ;

* The fissure was near to the lambdoidalsuture. Hippocrates, we are informed, mis-took a suture for fracture of the skull: whilst

upon great authorities, we may remark, thatthe same thing occurred to the illustriousJoe Burns. Ben Travers, in extenuationof his no-stone cases, says, that similarfailures occurred to Cheselden.—Hippo-crates and Joe Burns !-Cheselden and Tra.vers ! !-Sic parvis, &e.

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there was nothing remarkable in the stateof the pupils or in the respiration. On ex-

amining the head, the back part and leftside were found to be severely bruised, butthere was no fracture to be detected. Themeans had recourse to consisted in the ex-

hibition of purgatives, and the applicationof leeches to the temples. In the eveningthe pulse became sharp and quick, and thepupils dilated, the breathing also at thistime was laborious and noisy. She wasbled from the arm to the amount of eightor ten ounces, ten grains of calomel weregiven with a purgative enema, and thebowels by these means freely relieved.

28. The patient still continues in thesame insensible state, being completely un-conscious of surrounding objects; the pulseis small, but with some degree of jerk in itsbeat; the breathing is laborious; the pupilsmore dilated than natural, and insensible tothe stimulus of light. But the most strik-

ing and peculiar feature in the case was ex-treme restlessness and tossing about of thelimbs, seemingly produced by a spasmodicaction in the muscles, it was more espe-cially observed in the flexors of the leftarm.* Blood was drawn from the arm tothe amount of eight ounces, and leechesapplied to the temples.On the 29the, the patient continued in

the same condition ; the muscular jerkingsdid not cease until death, which occurredearly in the morning of the 30th.On examining the brain, a laceration was

found in the’left hemisphere, of about threequarters of an inch in length, and half aninch in depth. A laceration, nearly equalin extent, was seen in the right hemisphere,communicating with a cavity in the sub-stance of the brain above the ventricle, andcontaining about an ounce and a half ofclotted blood. There was also a slightlaceration at the base of the brain on theright side, and a small quantity of bloodand serum on the surface and at the baseof the brain. The arachnoid membrane was

opaque, and the cerebral substance through-out exhibited more bloody points than na-tural.

* We have seen this muscular agitation,in some few cases of injury to the substanceof the brain. In a case of chronic abscess ofthe brain, which fell under our observationsome years since, one of the most markedfeatures in the case was the agitation ofone leg and arm, resembling the motions ofchorea.

HOSPITAL OF SURGERY,Panton Square, St. James’s.

CASE OF ORGANIC DISEASE OF THE BEAIX.

Robert R., astat. 42, is affected withtotal loss of vision, so complete, that hecan with difficulty distinguish light fromdarkness. The eyes present no diseased

appearance, except an unvarying state ofthe pupil, and that deep-seated opacity,which is so characteristic of disease of theoptic nerve. He complains of an occasionalpain extending across the hemispheres ofthe brain. He experiences the sensation of £numbness in the fingers, and in the inferiorportion of the left half of the body to suchan extent, that when these parts are pinched,they give him no pain. His speech, althoughperfectly distinct, yet falters ; this symp-tom evidently arising from an imperfectcommand of the muscles of articulation.He is frequently attacked with violent andinvoluntary contractions of all the musclesof the body, and has often suffered frommost severe tonic spasm of the adductors ofthe thighs, also of the great pectoral muscles,which on one or two occasions lasted forfour hours, and produced an extreme de-gree of nervous exhaustion and intellectualconfusion. He is also subject to a retentionof urine, not depending on any obstructionin the urinary passages, but on a paralyticstate of the muscular coat of the bladder.His gait is extremely irresolute and totter-ing. The motions of his limbs are sometimesperformed without his volition, and in a

very imperfect manner. His mind, whichformerly was calm, composed, and calculat-ing, has now become exceedingly irritable,variable, and desponding, and his appear-ance but too well bespeaks the presence of" the mind diseased."

His general health is pretty good. He is

slightly dyspeptic. His pulse about 70.

Tongue rather foul.His business, the superintending of a

glass-manufactory, has for many years kepthis mind in a state of the most active exer.tion. Latterly, he has been subjected tomore than the usual unfortunate vicissitudesof life, which affected him in a very acutedegree. Eight years ago, the disease whichhas since so insidiously advanced, com’

menced with the appearance of phantomsfloating before his imagination while awake,and of frequent distressing dreams during’ sleep. These symptoms were succeeded bya gradual loss of sensation in the lower partof the left half of the body, and soon after byinvoluntary and spasmodic muscular con-traction. Three years since, his vision be-gan to fail. His complaints have graduallyincreased in severity, till they have attainedtheir present distressing condition.