29ago. The bowels hafor three days past ; be’10t been evacuatedtongue coated. Ordered its frequently ;ately- ke immedi- I

Calomel, 12 grains.Sulphate of quinine, 5 grains tt.,p

times a-day;House medicine, if required.

13. Bowels open ; pulse 6 j. ; fever less.14. Had a rigour last night at the usual

time, but says it was much more slight thanpreviously; the fever continued five or sixhours after. Is at present free from head-ach and fever ; has had no stool since yes-terday. House medicine daily, and conti-nue the sulphate of quinine.

16. Has had no shiver since the night olthe 13th ; free from pain ; tongue clean atthe edges ; bowels opened once yesterday.

20. Tongue clean and moist ; pulse natu-ral ; has no fever or rigours; put on housediet.The patient continued to improve, and

left the Hospital quite well, on Thursdaythe 26th of March.

ST. BARTHOLOMEW’S HOSPITAL.

SAMUEL TAYLOR, æt. 48, a tailor, short, andof a sallow complexion, was admitted intoColston’s Ward, under the care of Mr. Vin-cent, on Friday night, March 20, at eleveno’clock, with probably a dislocation of theright femur. The accident occurred by his

ing been thrown down by a cellar-door in-completely shut, projecting above the pave-ment. He was removed to the operatingtheatre, and extension made by the house-surgeon with the pulleys, but without beingable to effect a reduction of the dislocation.Considerable swelling in the neighbourhoodof the joint supervened, and lie was re-

turned to bed.11. Mr. Vincent considers that there is

a dislocation of the head of the femur,either upon the dorsum of the ilium, or intothe iceLiutic notch ! He has ordered the

pattent to be brought again into the theatre :Messrs. Ka))e, HoBd, and Stanley, agreethat there is dislocation. The patient hav-ing been placed on the table, and the pulleysapplied, extension was kept up for ten

minutes, and every effort made by Mr. Vin-cent to bling the head of the bone into itsnatural situation, but without effect. Thepatient was by nn means placed on the /table in the manner best calculated to afford

faettitv of reduction. In the course of theextension, it was thought a crepitus wasperceived, and after the pulleys were re- (

moved, a rigid examination, occupyingtwenty minutes, with a vie-w to detect frac-ture, was instituted by the surgeons alreadynamed, with the exception of Mr. Earle, whohad left the theatre. In the result, theyagreed that a fracture, accompanied withdislocation, did exist in the neighbourhoodthe joint, but of what, or in what particu-ar

rt, they could not make out. Thepoor n was, accordingly, again, for asecond tin returned to bed.

25. Since -,turday has experienced con-siderable pain aout the joint, but is nowsomewhat easier. n,e swelling is much re-duced. A cold lotion has been kept ap-plied over the part, and the bowels regu-lated.

28. Has been kept quiet till to-day with-out further examination, or renewed at.

tempts at reduction. Cold applications tothe hip-joint and neighbourhood, and aperi-ents have been the treatment. To-day Mr.Vincent repeated his examination, and, inthe result, expressed his satisfaction that hehad perceived crepitus and fracture in the

neighbourhood of the joint. He did not con.sider it judicious to be so rigid in his exami.nation, as to enable him to ascertain, with

any degree of accuracy, where, or of what,part the fracture was.

Mr. Earle, at this moment, entered thesame ward, and finding the nature of thecase to be stated as still ambiguous, desiredto be allowed to examine the patient. Onremoving the bed-clothes, he stated the po-sition of the limb was completely alteredfrom the manner in which it lav when hehad last seen it. On the former occasionit was inverted, the sole of the foot crossingthe dorsum of the foot of the sound limb,and presenting the usual appearance of adislocation of the head of the thigh-boneupon the dorsum ilii; but now the wholeextremity was lying straight in every re-spect, the toes pointing upwards, as theother. Grasping the parts about the jointwith one hand, rotating the limb with theother, and subsequently getting’ an assistantto rotate it, he declared he had found mostdistinctly, that there was dislocation of thehead of the femur upon the ilium, and afracture at the base of the neck. He feltthe head of the bone " like a cricket.ball,"as he said, motionless, while the femur wasrotating freely. He regarded the patientas a ricketty subject, and thought it highlyprobable the fracture had been occasioned

by the efforts made to reduce the disloca-tion. The patient did not fall twice, nor

receive any second injury when he felt.The length of the limb is as nearly as possi-ble the same as that of the other, thoughfrom a boy. till now, this leg had beensome what shorter than the other, owing tosome slight attack of disease about the hip*

30

joint, of which the patient cannot give a

distinct account.31. Remains quiet, and in the same po-

sition. No further attempt at reduction, orto bring the fractured parts in apposition,has been made. Mr. Earle described thehead to be situated nearly behind the treclianter major.

FRACTURE—PHLEBI

Thomas Haytred, aetat. r=, was admittedunder the care of Mr. Lawrence, February18, into Rahere’s Ward, with a fJacture ojthe tibia and fibula of the left leg, about4 inches above the ancle-joint. Has fairhair, is of a light complexion, and extremelyirritable disposition. The limb put up insplints, and ordered to be bled to eighteenounces, the pulse being full and the tonguefoul.

ialareli 2. A week after the bleediaig, in-nammatinn of the punctured veiu super-vened, and pus appeared to be secreted init. Ordered twelve leeches around theorifice and to take five grains of the com-pound coloc) nth pill.

4. The inflammation is extendir.g downthe arm, and the forearm is swelled. Applyeighteen leeclles mr,re.

o. Inflammation still extending down thevein and forearm ; and the hand consider-ably swollen. Apply twelve leeches, andwrap the limb in a poultice.

6. Apply twenty-four leeches.9. There is evidently an induration of the

vein, extending iloul the orifice downwardsfor about six inches. The swelling is some-what abated, and the inflamu2atiun subsiding

18. The arm, to which the principal at-

tention has hitherto been directed, is stillgoing on well. The inflammation never

extending above the orifice made by thelancet, but descended along’ the forearm andinto the hand. The hardness, which, to

the touch, very much lesembles a strongtendon, is gradually subsiding, and the poul-tice may now be left oif.

30. The arm is now quite well ; the bonesof the leg united, and the-patient is fast re-covening. During the inflamed state of thevein aLll arm, no particuiar constitutionalderangement tock place. ’lhe tongue occa-sionally was brown and coated, the patientirritable (habitually so) but nothing !ur:ht’r.The rat.f’nt is a sawyer, and the leg wasbroken by a piece of ti:nher falling up on himhis arm likewise received a blow at tilesame time.

FRACTURE.

Judith Haywood, K’tat. 60, was admittedon Sunday morning, 9th of March, intQueen’s Ward, under the care of lie. Law-

re of the right leg nearrence, with a first, supposed to be of bothto the ancle by a fall down some stepsbones, case. The patient is a strongof’ a dark complexioned, a dram drinker,has obtained her living lately by sellingoysters in the streets. The limb put up in afracture box, and aperient medicine ordered.

12. Last night became delirious, got theleg out of the fracture box, got out of bed,broke some of the windows in the ward, andconsiderably injured the leg, before shecould be secured. She has now been re-

moved into another ward, has the strait-waistcoat on, and is in a tate of the great.est mental excitement. Last night thetincture of opium; to a considerable extent,was administered by the house-surgeon,which, in the end, procured a little rest.Ordered a drachm of the dilute sulpliuricacid, an ounce of the syrup of orange pee),and tliree ounces of the syrup of roses, ofwhich a wine-glassful is to be taken everytwo hours, also an enema.Nine o’clock, P.m., ratlier more quiet, but

still very restless. The bowels have notbeen moved. Take a drachm of the tinc-ture of opium every four hours.

13. Is now quite collected. From nearthe head of the tibia, as low down as to themiddle of the dorsum of the foot, the limbpresents a tumid and gangrenous appear-ance. Complains of great depression andweakness. Ordered a small quantity of

brandy and water every hour.14. She died last night. On examining

the leg, the fracture was found to be ofboth bones, and extended into the ancle-

joint. The vessels of the brain, and its

coverings, were greatly distended, and thelateral ventricies filled with water.

SOMNAMBULISM.

Thomas Barrow, ætat. 50, admitted into,B-o. 11, Colstou’s Ward, under the care ofMr. Vincent, with fractured ribs and em-physema. ’lh patient dark-complexioned,a muscalar man, and by trade a sawyer.Was admitted at one o’clock on Sunday.the lltii of September. Ftom a child hadbeen in the habit of occasionally getting upat night, and walking in his sleep. so atur-day night had slept in a strange bed nearHighgate, and as he had often done before,ot up to make Ins nccturuat perambulation.Supposes he n.ust have taken the window

for the door, not having been able to find thelatter; opening it, he leaped out of theloom, and fell a distance of thirty feet. theshock awoke him, and his cries broughthim assistance. lIe was unable to move.When brought to the hospital, there wasconsiderable emphysema over the chest, audfracture of the ribs, but, in consequence

31

of the very acute pain examination occa-sioned, it was not ascertained how manyof the ribs were broken. The fracture

banrlage was applied, and he was bledad 3x.Ordered

R Hydrag. dublur., gr. iij. c.;Pulv. jalap., xv. statim.

R Mag. sitlpla. ;

Liq. ammon. acet., a. a. 3j.;Spirit. œther. nit., 3ss.Aquœ purœ, 3viij. M. Sum. coch., ij.2da quaque hora.

15. Venesection ad xvj. Feels better.Passed a restless night, though better thanthe night before. Pulse small and wiry,120. Ilarassed with a cough, which liehad before the accident happened.

17. The emphysema greatly subsided.The bowels have been opened. Has sleptwell, and, on the whole, feels improved.Pulae strong, 101.

19. Continuing to improve.Oct. 23. Discharged cured.

ERYSIPELAS.

Henry Woodtow, ætat. 30, a workingsilversmith, admitted into Darker’s Ward,undd the care of Mr. Lawrence, March3rd, with phlegmonous erysipelas of the

right leg, and suppuration partially makingits way extemally. Was not sensible of

having received any injury. Slight pain,swelling, and redness, eupetvened, whichinduced him to come to the lospital. The

leg is now much swollen, and the inflamma-tion exter-ding from close to the knee downto the ancle-joint very considerable. Mr.Lawrence has made an iitcisioii near thecnurse of the posterior tibial artery, throughthe shin and fascia, eight inches in length.Otdered apenient medicine, and afterwardsthe ratine mixture. ’

11. The wound has discharged a gooddeal. Has a healthy appearance about theedges, but rather unfavourable in the centreto the extent of about two inches in theIiliddle of the leg.March 31 Wound proceeded healingslowly, and the patient is now almost ableto leave the hospital.

FRACTURE.

Richard Hatris, aetat. 30, was admittedinto Rahere’s Ward, March 26, under thecare ot Mr. Lawrence, with the right handseverely lacerated, and a comminuted frac-ture of the carpal ends of both bones of thefore. The accident occurred betweentwelve and oue o’clock. The patient is a

strong healthy man, of a fair complexicn,and sandy-coloured hair. Mr. Lawrenceconsidered that the only mode of proceed-

ing was, to remove the injured parts; and,accordingly, the patient was conveyed to theoperating theatre, and amputation, at themiddle of the forearm, immediately per-formed. The arm was supported almost

horizontally from the body of the patient,and in such a position as to bring the radiusdirectly over the ulna. The operator thenintroduced a double-edged knife on theinside of the radius, thrust perpendicu-Jarly down, until it projected below theulna close upon its inner surface ; the knifewas next cairied a little towards the palmof the hand, was then turned, and a flapmade by dividing the soft parts in the re-moval of the knife. A flap was made onthe outer side of the arm in a similar man-ner. The inter-osseous ligament then di-vided, and the bones sawn through fromwithout inwards. With a pair of scissors,the projecting ends of several tendons wereremoved, four ligatures applied, the Hapsbrought together, and the patient thentaken to bed.’ This form of operation was, in a great mea-sure, novel at this hospital, and it was notconsidered to have been neatly performed.

27. Between eight and nine o’clock lastnight, hæmorrhage from the stu:np took

place ; the straps were removed, four morearteries secured, the dressing again applied,cold cloths resorted to, and the further

bleeding suppressed. In about half an hourafterwards, sixteen ounces ef blood weretaken from the left arm, and the patieutordered to be kept quiet.

31. Going on pretty well. The arm is

slightly tumid and innxmed, but the patientexpresses himself comfortable ; the diess-

ings have been removed, healthy pus is se-creting, and there is every reason to believethe result will be favourable.

WILLIAM RAY.—DUBLIN ANATOMISTS.

Tu the Editor of THE LANCET.

SIR,—With reference to the communi-cation from Erinensis, inserted in yourlast Number on the exportation of subjectsfrom Dublin, I take leave to observe, thatinstead of Wilson Rae, I believe WilliamMao ought to bu read. Now under this de-romiuatiou, Sir, you will find a member ofthe College of Surgeoii,3 of London; or, to

be moi particular, he is designated WilliamRae, R N. Erinensis is mistalcen in callinglir. Hae (whicli should be spelt Ray) a

Scotsman. He is a native of tne Isle ofMan. Mrs. Ray is a countrywoman of hisown, and a native of Dublin. Er;nensis