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public censure? How comes it, Mr.Editor, that you have overlooked so fla-grant an abuse-you who are constantlyendeavouring to discover abuses that youmay correct them, and who have alwaysshown yourself to be the patient’s friend ?It has always appeared to me, that, as

soon as any improvement is made in theprofession, it is the duty of its membersto adopt it for the benefit of their pa-tients. If surgeons will not have re-

course to the best modes of treatment,what is the use of attempting to im-

prove the profession ? Those whoseconsciences are so seared that they are nolonger sensible to the cries of their suffer-ing fellow-creatures, or who from somepetty feeling cannot be brought to adoptany improvement emanating from a

contemporary practitioner, are unworthyof a liberal profession. But I refrain fromsaying any thing further upon such con-duct, feeling satisfied that you will treatit as it merits.

I hope, Mr. Editor, that you will finda corner in your widety-circutated Jour-nal, for the insertion of this communica-tion, in order to show the profession andthe public,that improvements in the medi-cal profession shall not be made in vain.

I am, Sir,Your constant reader and well-wisher,

AN OLD BOROUGH STUDENT.

April 2, 1826.

HOSPITAL REPORTS.

GUY’S HOSPITAL.

Compound Fracture of the Leg.John Wetherell, aetat. 40, a stout man,

but of lax fibre and sallow complexion,was admitted into Guy’s Hospital on the23d of March, under the care of Mr.

Morgan, on account of compound fractureof the left leg.The seat of the fracture was about two

thirds down the leg ; on the inside of theleg at this point, was a small obliquewound, through which the upperfractnredportion of the tibia protruded. The fibulawas also broken.The accident occurred only a short time

before admission, under the following cir-cumstances : a fellow labonrer was in theact of placing a box of lemons (weighingthree cwt.) on the back of the patient,when the foot of the former slipped. The

load not being property adjusted causedthe patient to stagger, and eventuallyfall, the box falling upon his le.The portion of bone that protruded was

small, and was not firmly girt by the snr-rounding integuments. By means of mo.derate extension it was reduced, and theends of the bone readily brought intoapposition. The wound was dressed inthe usual manner, by first applying a pieceof lint, and over that strips of adhesiveplaster. The limb was placed on its outerside, and cold lotions applied.Here was a case ofcompound fractnre,

by no means of a severe nature, and onein which a favourable issue might be an.ticipated, if we looked merely to theextent of injury done. But the constitu-tion of the patient was defective, thesallow complexion and lax fibre bespokesomething wrong ; on inquiry we foundthat he had been a man of very intem-perate habits. Of late, (being in lessaffluent circumstances,) he has been moretemperate, but still in the habit of drink-ing large quantities of porter daily.On the sixth day after the accident

this case began to assume a serionsaspect ; the pulse was very quick, therewere great restlessness and agitation ;the countenance expressive of anxiety.The limb was much swollen, and the in-teguments were of a dark redcotour ; at

different parts of the inside of the legwere vesicles. The symptoms of irritation manifested themselves on the thirdday after the accident. Previous to this

report, matter had formed at some dis-tance above the point of fracture, whichwas evacuated ; all the bandages wereremoved from the limb and a poultice wasapplied; the limb being placed on theheel in a fracture box. He now takes amixture of ammonia with 20 drops oflaudanum, every four hours, and two

grains of opium at bed-time. He has beenallowed three pints of.porter daily fromthe time of his admission.

April 1. This is the ninth day from thereceipt of the injury. The irritation andrestlessness have greatly increased ; heis in the highest possible state of nervousexcitement, and this not proceeding se-condarily from vascular action, but from

the injury as it were falling directly onthe nervous system. Hence there is in-

voluntary and spasmodic contraction ofvarious muscles, great agitation and de-lirium. The pulse is quickened; but it isfeeble ; the tongue is moist. There areseveral sloughs on the inside of the leg,at those parts in which the vesicles madetheir appearance. Poultices are appliedto the limb. The following mixture wasprescribed to be taken every four hours:

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Subcarbonate of ammonia, 8 grains,Laudanum, 20 drops,iJl1tsk 7)iixtu,)-e, (P.L.) 1½ ounce.

2. Symptoms not abated ; he becameso restless lait evening that he got out ofbed. A large dose of opium was given atnight, which had the effect of quietinghim for some time. The pulse is veryrapid, the tongue moist. He was or-

dered to continue the mixture prescribedyesterday, with the addition of half adrachm of Hoffman’s anodyne liquor toeach dose. The appearance of the limb;s much the same; there seems to be an

imperfect attempt on the part of natureto produce suppuration in order to dis-

charge the sloughs.4. There is much less irritation to-day;

the pulse continues quick and tonguemoist. A portion of sloagh immediatelyover the seat of fractnre has separated,and matter is discharging.

Sir Astley Cooper saw the patient to-day ; he seemed to be of opinion that itwas possible to save the limb. In conse-

quence of the patient’s extreme restless-ness, which continued until last night, itwas found impossible to retain the limb inany single position, and therefore, whenSir Astley visited the man, he found thelimb laying as it had been placed by thepatient himself. It had sunk down intoa depression of the bed, and certainly wasfar from being in an eligible position. Sir

Astley proceeded to place the limb on

pillows, so as to elevate it considerablyabove the level of the patient’s body ; a

splint being placed on its outer and inneraide. The poultices to be discontinued,and dilute nitric acid lotion to be appliedto the sloughs.

(Sir Astley Cooper was evidently se-duced into a favourable opinion of thiscase from the comparatively quiet state inwhich he found the poor man. The factof the limb being in a bad position arosefrom the circumstance before mentioned,viz. the incapability of retaining it in anysingle position.)

6. Suppuration to a great extent is nowgoing on throughout the whole of the limb.The slongh over the seat of fracture hasseparated, and the bone on moving thelimb protrudes at the opening. The con-stitution has rallied a little, there is lessnervous excitement. He continues totake the anodyne mixture; poultices areagain applied.

7. The propriety of amputation wasconsidered of by Mr. Morgan to-day. Heremarked that it was utterly impossibleto save the limb, and as in a short timemore extensive suppuration would ensue,a large demand would be made on the

constitutional powers, which were alreadyso much enfeebled, that the patient wouldeventually sink. He observed also thatamputation would donbtless prove asevereshock, umler present circustances, but asit was a choice of two evils, with the cer-tainty of death oit the one hand and a

probability of success on the other, therecould be no doubt which should be chosen.The sloughs are separating, and matteris pouring out from different parts of theleg, but more especially from the place offracture. The pulse is feeble, the tonguemoi,,,t, it was remarked that the tonguehad been moist throughout the whole ofthe patient’s indisposition.

8. The sloughing and suppuration of thelimb are going on, the integuments ashigh as the knee are diseased. Mr. Mor-

gan deeming any further delay imprudent,proposed that the operation should beperformed to-day.

Operation.It was. found necessary to amputate

above the knee. The incisions were

made, and the bone sawed through inthe u,ual manner; a considerable gush ofvenotts blood followed the incisions.-There was one circumstance, attend-ant on the operation, which we deemparticularly worthy of notice. After thelimb was removed, and when the tourni-quet was loosened, preparatory to se-

curing the arteries, numerous streams ofblood issued from the face of the stumpas if from a sieve. This blood was fromthe veins, yet in fact they poured outtheir blood in a similar manner to ar-teries.* The tourniquet was entirely re-moved, and pressure was made on the

femoral artery in the groin, when the bleed-ing ceased.

It would be tedious to give a detail ofthe daily state of the patient after theoperation. In fact, the symptoms which

* Under similar circumstances that" meritorious you!!:; surgeon"* JohnShaw applied a ligalure to each bleedingvein. To be sure this only occupied anltour and ten minutes, and doubtless gaveto the stump what Mr. C. Bell would

style an ., elegant appearance." If suchbe Mr. Shaw’s practice, who shall denythat he has many ties on his patients.Perhaps there was some ., irregular dis-tribution of arteries" on the stump. Goddeliver ns from the hands of such men asJoe Burns and John Shaw, and from theamputations of Ben Travers.

* A specimen of " moonshine," Johnson’s blarney! Caw me, caw thee ?"

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came on the second day after amputationhave been uniformly the same from dayto day. They were of the same characteras those which supervened the accident-high nervous excitement with great wantof power. On the 15th of April we sawthe stump, there did not appear to be theleast attempt at reparation ; a fungousgrowth was thrown out from the medul-lary structure of the bone. Large andrepeated doses of opium are given to himwith temporary benefit. Poultices are

applied over the stump.On 22d of April we had an opportunity

of observing the state of the stump, thereseems now some disposition to granulate.We visited him dailv throughout the week,and found but little change in the symp-toms ; some days appearing to rally a

little, at other times we find him appa-reittly sinking. He has taken the blackdrop with some benefit. It is only a mat-ter of surprise to us that nature shouldso long have withstood the struggle ; her emains in a state from which recoveryia scarcely possible.

ST. THOMAS’S HOSPITAL.

Disease of tlte Heart-Use of the Stethos-cope.

The utility of the stethoscope in ena-

bling ns to form a more correct diagnosisof diseases of the chest, is now well esta.blished. All those who have taken the

pains to investigate its merits, are fullysatisfied therewith, and it is only rejectedby those who are content to remain inthe " biiss of ignorance," or whose stiff-necked pride of education will not permitthem to become scholars in this art.

Hume, in his history, informs us, thatfew men in England above the age of

forty believed in the doctrine of Harveywith respect to the circulation. So dif-ficult is it to shake off the trammels of’education.The opinions pronounceli or the fol-

lowing case were pJ’inc;pally derived fromthe use of the stethoscope, and the post-mortem examination fully confirmed theiraccuracy.Owen Sweeney was admitted into St.

Thomas’s Hospital, October 27th, 1825,nnder the care ot Dr. Elliotson. He hadsome degree of ascites, and the legs wereanasarcoos ; there was a slight oppres-sion of breathing, but he could lay downwithout inconvenience. It was remarked,that the external jugnlar veins were

greatly distended, especially near to the

n angles of the jaws; the radial pulse wasquick and irregulr.

Stethoscope.-Un applying the stethos-t cope over the region of the heart, a rust-v ling noise was distinctly heard under thee cartilages of the third and fourth ribs.s This noise so much resembled a rush ofair throngh a narrow opening, that at

first it was imagined to be a respiratorynoise, but by carefully observing the pe-eriods of inspiration, it was found that the

noise did not correspond therewith. Anadditional confirmation was found by ap-

playing the finger to the radial artery,e when it was discovered that the rtistlingnoise and arterial pulse were synchronous.. Diagnosis 1st.—From the noise it wasa inferred, that one of the orifices of the- heart was diminished. 2dly. From theB: absence of signs of obstruction in the

- tungs, such as great dyspnœa, and a bloat-ed livid countenance, and from the noisebeing heard over the right half of theheart, it was inferred that the diseuse was

situated in the right half of that organ.3dly. From the noise being synchronouswith the pulse, evidently occurring at thecontraction of the ventricles, it was iu-ferred that the obstruction existed at thecommencement of the pulmonary artery.

4thJy. From the dilatation of the jugu-tars, it was supposed that the right stdeof the heart was dilated, and the ascites

was imagined to be independent of thedisease in the heart, and to aris" fromhepatic affection, illasmnch as there wastenderness on pressure in- the right hypo-chondriac region, and the man had beenin warm climates.

To cure the disease which was believedto exist in the heart, was impossible; brrtthe patient was alloNed to remain in thehospital, and died of a bronchial affectionrm the 30th of March 1826, being a pe-riod of five months from the date of his.tdmissioll into the hospital. Whetherthe lungs became diseased in ronseqnenceof their intimate connexion with the heart,or whether the disease depended on com-mon causes, such as exposaro to cold, isof course matter of equal probability.

Inspectio Cadaveris.

Thorax.—The loose pericardium was

found to be completely adherent to thaton the surface of the heart, so that, infact, there was no pericardial cavity. Theright sinus venosus was greatly dilated,and consequently the opening betweenthe auricle and ventricle was cousidel ablydilated. In the right ventricle, on the