315MONSTROSITY.—DELIRIUM TREMENS.

amined. I have met with caees which re-sisted every remedy, till it was ascertainedthat the patients had given erroneous ac-counts respecting the number and appear-ance of the stools; and upon the bowels

being put in roper order, the disease hasgiven way without any further trouhle.From the idea that intermittent is a disease

of debility, many practitioners give nourish.ing and stimulating diet, with wine, in all

cases; but after the pathological accountwhich I have given, and the appearancesfound on dissection, a word more need notbe said to show the impropriety of suchconduct. In some instances it is beneficial,where there is no local disease, in others itmust prove prejudicial.-* The patient shouldbe clad according to the season of the year,and the temperature of the climate. Heshould avoid exposure ill bad weather, andparticularly in our climate during the preva-lence of easterly winds, and keep to thehouse after sunset, till he is sufilciently reocovered."

This extract is sufficient to show, that thework deserves the highest station in me.dicallibraries.

LONDON MEDICAL SOCIETY.

May 25th, 1839.

Mr. CALLAWAY, President, in the Chair.

(The last Evening of the Session.)KfTAL MONSTROSITY—DELIRIUM TREMENS

-OTITIS-CLOSE OF THE SESSION.

THE Minutes of the last Meeting wereread.

M;!. FENNER exhibited a specimen of

monstrosity. The patient from whom it hadbeen taken, was a woman at the full periodof utero-gestiitioti, to whom he was called.At’ter delivering her ot a perfect living child,Le thought there was stil, something in theuterus, but from the size of the abdomen,did not expect there could he another child.

* It is quite unnecessary to notice thepractical recoramendations of Dr. M’Cul-loch, who has not practised since the lastcentury, but who, in the year 1827, hastaken upon himself to write a practicalwork. It is surprising that a geologistthonid be allowed to occupy a patho!oO’icalfield of inquiry, without being blown out ojit into his own proper sphere ! ! I entertair.great respect for Dr. M’Culloch, as ache.mist and geologist, but certainly hold himvery cheap as a pathologist.

On introducing his hand, however, he dis.covered an extremity, and, with slight as-sistance, brought away the monster whichwas now before the society. There was butone extremity, which terminated in a sort ofclub-loot, and was attached to somethinaiesembling an abdomen. At the oppositeend was a growth, which seemed designedfor the head, but it had neither ears,

eyes, perfect nose, nor mouth, though it ex-hibited a sort of profile, with the appearance; of a nose. It was attached by the navelstring to the placenta of the other child.

Before the navel string was cut, there wasa very indistinct pulsation in it, but all vi.tality seemed to leave the moment it wasdivided. As far as had been traced, there

was nothing representing heart, lungs, or

stomach. lIe intended to dissect it at afuture period, and shcuid take an opportu-nity of detailing the appearances.The REGISTRAR read a paper, detailing

the circumstances of a butcher, 43 years ofage, who had been attacked with deliriumtremens, which had proved fatal, with anaccount of the post-mortem examination byDr. Hodgkin. The patient had been atw,

tended by Mr. Callaway and Mr. Iliff. Hehad been a hard drinker, as well as a labo-rious man. For a long time past, he hadbeen unable to get out of his bed, and put onhis cloti:es, until he had drank a pint ofporter and a glass of gin ; immediately ongetting up, he had been in the habit ofadding to that, half a pint of ale, and hewould not let many hours of the day pass with-

out doing homage at the shrine of Bacchus.

On Saturday h& was taken ill ; lie had ex-treme difficulty in lifting his hand to his

mouth, when he attempted to take fluids;he had also huskiness and inflammation ofthe throat. Between the time of his being’ taken ill and the following night, he wascupped, had leeches and blisters appliedand opium and aperients administered, whichseemed to have given him relief. Eariy onMonday morning, however, he was seizedwith a violent paroxysm which carried him

o!T. Dissection exhibited a turgidity of all thevessels of the brain ; some ossific patches ofthe dura mater, and a considerable quantityof puriform matter expressible from the

lungs. -

Dr. RYAN wished to know on what prin-ciple this case had been treated.

Mr. ILIFF said, that at the beginning ofthe complaint, a few ounces of blood weretaken away by cupping ; as there was evi-

dently a pharyngeal affection, ieeciies were

applied about the throat ; opium was given,and the bowels were opened, which for atime afforded considerable relief. The dif-

ficulty he had in swallowing, and the con.vulsions lie laboured under, when fluid was

316

offered to him, at one time created an im- Ipression that he had been affected with hy-drophobia, which impression increased for a Itime, when on its being recollected thatsome few weeks previously, a puppy withwhich he had been playing, had slightlybitten him. This notion, however, was soon effaced, the dog being now alive and per- Ifectly well.

.Mr. DENDY, a new member, introducedthe subject of otitis. He considered thisdisease among children during dentition,much more common than was generally be-lieved, and that it was a subject well de-serviug of the consideration of the society.His treatment consisted in the applicationof leeches and poultices behind the ear; inthe exhibition of calomel and laxatives, andin keeping the patient cool ; absorption ofthe bones generally took place, and effusionof matter between the dura mater and thebones, which destroyed life. JIe exhibiteda portion of absorbed bone which he hadtaken from a little patient 4 years of age.

Dr. BuRN directed the attention of the

society to the anatomy of the parts con-

cerned in ottorhoea, or otitis, on the ravagesit made, and to what he conceived to be theproper treatment. The first symptoms ge-nerally were, paius in the ear ; suppurationensued, inflammation of’ the cavity of thetympanum followed, and pus was dischargedinto the mastoid cells, it then found its waythrough small foramina, in the petrous por-tion of the temporal bone into the brain ;and either through this, or by an attack ofmeningitis, patients lost their lives. Thewhole danger of the disease consisted in theaccumulation of pus, which could not find anexit ; and the object in the treatment was,if possible, to prevent that accumulation.At an early stage of the disease, this couldonly be done by injections. Though thecomplaint had extended very considerably to-wards the brain, provided injections couldbe had recourse to, even if it were neces.

sary to apply the trephine for the purpose,a cure might in many cases, be effectedThe disease did not take place at any par.ticular period; patients became the sub-

jects of it at 14, 20, 30, or 40 years ofage, and it might go on for 15 or 20 years.He had examined a man 42 years of age,who had recently died of this disease. Thebrain generally presented a very vascularappearance ; it was firm and more thanusuallv vascular, and the membranes wereparticuiatly so, especially in the neighbour-hood of’ the diseased bone. He believedthere was ro part of the dura mater absorbed, so as to admit matter to enter be-tween it and the arachnoides. IBIatter, how.ever, had found its way from the mastoidcell:" to between the dura mater and the skuJl.There was a small quantity of it in that

I situation in the neighbourhood of theear. Great pain had been experienced inthis case over the mastoid process, and con.siderable enlal gemen of the parts coveringit. Mr. Callaway had seen the case; andhe (Dr. B.) believed it to be that gentle.man’s opinion, that if another such case

should present itself to him, he would nothesitate to trephine.The PRESIDENT stated, that when he saw

the man alluded to, he was labouring underparalysis of the left cheek (the diseasedside) and there was a large tumour in theneighbourhood of the mastoid process. Six.teen years previously he had been thrownfrom a cart, at which period the pain in thehead commenced. It continued for a longtime, and medical remedies were resortedto. Shortly after the accident a dischargefrom the ear appeared, which was in thecourse of time arrested by stimulating injec.tions, but from that moment the pain in.creased, and rose to such an extent, that hewas under the necessity of reviving the dis.charge by the introduction of probes. V henhe succeeded in this, the pain graduallysubsided, and the discharge continued with-out much pain for a very long-period. The

pain latterly became most excruciating. He(the President) made a free opening intothe tumour before alluded to, which wasfollowed by a very foetid discharge, muchresembling, in all respects, that which issuesfrom diseased bones. Introducing a probethrough this opening into the mastoid cells,they were easily broken down. He carriedthe probe through them into the internalear, from which a second evacuation took

place, which seemed to give great relief. Adossil of lint was introduced into the open-ing, the discharge kept up, and the butcherenabled again to attend to his business.Some time afterwards the discharge againceased ; the pain was renewed, and againhe called on him. At this time Sir AstleyCooper was requested also to see the case,and it was thought that the trephine shouldbe applied. The man was in great agony,and willing to submit to any thing. A dayor two passed away ; another consultationtook place, at which the operation was de-cided upon, but in the interim the patientbecame suddenly comatose, and died.The President had seen another case of

this sort, which proved fatal, in which theinternal ear was destroyed, together with avery considerable portion of the cerebrum.

At the close of the evening, the President,addressing the members, said, " It becomesnow my duty to inform you, that this is the!ast night of our meeting for the presentsea-son, and we shall adjourn from this eveningto the evening of the last Monday of nextSeptember. As your President, I feel very

317

much hOnoured and obliged by the attentionyou have paid by your attendance in the

Society, to the various subjects that havebeen introduced to its notice. Though oc-casionally, we may have felt the want of

subjects for discussion, I am sure that thishas not been the case dming the last few

efeniugs, which have been peculiarly inter-esting. I feel that it is only necessary forus to proceed in the same course, to main-tain that reputation which this Society, asthe parent of all others, ought to enjoy-the,Society from which every similar institutionin this great metropolis has sprung ; andwlnle it ought to set an example to them, Iam satisfied it is capable of continuing to beevery thing its members can desire. Theaccumulation of facts, the discussions to

which they give rise, and the association ofmembers, are fraught with advantage, andmust do honour to our profession. Trustingwe shall all be usefully employed betweenthis and the next session, allow me in con-clusion to wish you every comfort and hap.piness until we meet again." On the table of the Society were several

acoustic instruments, for cases of confirmeddeafness, which had resisted every attemptat cure, laid there by Mr. Curtis, whose re-marks the President regretted the latenessof the hour had prevented him from hear-ing. Sir Edward Stracey’s lately inventedinstrument was amongst them. It consistedof the usual ear trumpet, with the additionof a flexible tube for the mouth, by whichthe power of hearing is importantly in-creased. Of this apparatus Mr. C. expresseda very favourable opinion. There were alsosome artificial ears of silver, &c. closelyadapted to the frame of the ear, for collecting sound, and an acoustic trumpet with slides,similar to those of opera glasses, for the

pocket.

ST. THOMAS’S HOSPITAL.

COMPOUND FRACTURE OF THE LIG.

EDWARD HANFRY, an interesting little I,fellow, four years of age, was conveyed intoKing’s Ward, No. 21, on the 15th of May,at about five in the afternoon, with a com-pound fracture of the tibia and fibula, at theiutddle third, caused’by a cart wheel runningover the leg about an hour previously. Thereisa (leeply-incised wound extending from the spine of the tibia, to more than half roundthe leg, dividing a large portion of the gas-trochemi musctps; about half an inch ot thetibia is denuded, and the upper portion pro -jecting through the wound over the lower.A person was immediately despatetied forMr. Green, who attended at about seveno’clock, and found it necessary to remore

the projecting portion of bone, but had con-siderable difficulty in overcoming the foolishopposition of the mother, who was presentthe whole of the time ; having set aside herscruples ; the operation was performedwith Hey’s saw. The child did not appearto suffer greatly, but the parent seemedmuch agitated, perhaps more so than theoccasion required ; but some -allowanceshould be made for the feelings of a motherin such a situation, and, in our humble opi-nion, the tittering and langhter of the sur-rounding pupils might have been spared, at

least the oath of one tall gentleman, whosename we need not mention, might, withoutany impropriety, have been omitted. Afterthe removal of the end of bone, the frac-ture was reduced without much further dif-

ficulty. The wound was dressed with somelint dipped in the blood, and a pair of com.mon splints placed lightly one on each sidenf thf limh.

16. Was very restless during the formerpart of the night, until five minims of tinc-ture of opium were administered, sincewhich he has been more composed, and nowappears perfectly cool and free from pain.

17. Going on well.18. Has passed rather a restless night,

and now complains of pain at the left side ofhis head. Bleeding at nose, thirst; pulserather quick. Bowels have not been movedsince Thursday last; but has taken somecastor oil this morning.

i 19. No evacuation from the bowels; hastaken three doses of castor oil. Still com-plains of headach ; skin hot.

’

20. Has passed a better night; bowel,$have been moved once.

21. Rather a restless night, but cool andcomfortable now. Wound looking healthybowels open.

’

23. Free from pain, and going on well.26. Appetite good ; bowels open ; skin

cool. Doing well in every respect.

RHEUMATISM.

John Connor, mtat. 19, was admitted intoEdward’s Ward, No. 6, on the 14th of May,under the care of Dr. Elliotson. He states,that he caught a severe cold about a weeksince, and had shortly afterwards a sensa.tion of numbness in the right shoulder, ex.tending up the neck on that side, which wassoon succeeded by severe pain on the rightside of the head, imperfect vision, giddiness,especially on moving or turning quickly,and pain of the right shoulder, graduallyincreasing up to the time of his admis-sion. Says the headach, pain, &c., alwaysbecome worse at about four o’ciock in theafternoon, and continue so during the

gieater part of the night. There is increasedheat of skin, especially over the head. His