429

Madder about ten minutes previous to

the occurrence of the accident.The patient was placed in bed, cover-

ed with warm clothing, and bottles, filledwith hot water, were applied to the feet.There was something peculiarly charac-teristic in the position of the patientwhen in bed ; he lay on his right side,with his thighs bent upon the body ; it is

worthy of remark, that there was at thisperiod no tumefaction of the abdomen;the integuments were slightly ecchy-mosed.t At five o’clock the radial pulse had notrallied in the slightest degree ; there was,however, a little warmth on the surfaceof the body. The dresser introduced acatheter, but could not pass it furtherthan the prostate gland. At the con-clusion of the surgical lecture Mr. Greenvisited the patient, (this was about nineo’clock.)

, The abdomen was now considerablydistended, and the patient complaining ofexcruciating pain ; the pulse had not in-creased either in force or frequency. Mr.Green succeeded in passing a catheter,and drew off about three-quarters of apint of urine tinged with blood. He di-rected warm fomentations to be appliedto the abdomen, and thirty drops of lau-dannm to be taken immediately in cam-phor julep; this his stomach almost in-stantaneously rejected.

’

At midnight the dresser visited the pa-tient, and found him still complaining ofagonising ’pain; there was great thirst,.and he frequently and eagerly drank oftoast and water. Pulse still feeble.

22. At nine o’clock in the morning wefind that no improvement has taken placein the condition of the uatient: the cir-cttlatiom is stilllangnid. The poorman ex-presses great apprehension of death; theabdomen is very much distended and pain-ful upon pressure, and the same positionis observed as at first, namely, lying onthe right side with the thighs Hexed. Thepain is still excruciating and thirst un-abated. During the night a small quan-tity of turbid urine was passed, and thepatient obtained about three hours’ sleepfrom a dose of laudanum which was ex-hibited to him by the dresser at midnight.At three p.m., we found the poor man

evidently fast sinking, the pulse at thewrist was scarcely distingutshable, thepain, distension of the abdomen, andother symptoms enumerated above con-tinue unabated. ’

At six p.m., the, pulse had entirely for-saken the wrist, the taper of life, how-ever, continued faintly glimmering formany hours, and it was thought advisableby the dresser to administer some stimu-

lant, in order to fan that spark of life(hopeless task!) which yet remained;with this view the dresser applied to theapothecary for some wine, about half-pasteight o’clock in the evening. Mr. Whit-field with that laudable anxiety for thepatient’s welfare, which so peculiarlycharacterises him in the discharge of hisarduous duties, requested Mr. Whitfield,junr. to visit the poorman. Be it remem-bered at this period the pulse was notperceptible at the wrist, the extremitieswere cold, and the features collapsed.the following plan was directed :

Twenty-four leeches to be applied to theabdomen, and the warm fomentations to becontinued !At ten o’clock, according to the report

of Mr. Tyrrell’s dresser, which was readat the Clinical lectnre, the patient wasevidently dying, this we suppose was notthe opinion of Mr. Whitfield, junr., for hedirected the further application of twelve

’ leeches to the abdomen ! ! /At eleven o’clock the patient expired,

during the application of the last leeches.Post-mortem Examination.

On laying open the abdomen, the peri.tonemn lining the parietes, and also thatportion investing the intestines, was

found in a - state of extreme vascularity,and this more especially on the right sideof the abdomen. A layer of soft yellow-isit lymph was spread over the whole sur-face of the peritoneum, and the convo-lutions of the small intestines were gluedtogether by means of this adhesive mat-ter. There was a considerable quantityof a brownish-coloured fluid in the cavityof the abdomen, in which were portionsof alimentary matter, and upon tracingthe intestines, a rupture zvctc found in thejejunum, about three hands’ breadth fromthe termination of the duodenum. The

opening in the intestine was of sufficientsize to admit of the little finger. Theduodenum was found to be filled withhalf-digested food; its internal surfaceand also that of the stomach presented ahealthy appearance. In addition to theextreme vascnlarity of the peritoneal co-vering of the intestines, there were, indifferent parts, distinct spots of ecchy-mosis or extravasation ; the mucous mem-brane was free from disease.

ST. BARTHOLOMEW’S HOSPITAL.

Morbid Anatomy-Typhus Fever.Last week, Dr. Latham sent Mr. Stan-

ley some extensively diseased intestines,(taken from a female who had died theday previously of typhus 1’ever,) which

430

he was desirous should be shown to thepupils. The symptoms being at no timeso severe as to indicate any such exten-sive visceral disease. The valvulas con-niventes of the jejunum were consider-ably indurated with a deposition of avery thick kind of lymph, which it wasrequisite to scrape off before the mucousmembrane could be exposed. This mem.brane was highly inflamed, and in someplaces distinct patches of ulceration,about the size of a pea, had extendedthrough the coats of the intestine to the

peritoneum, more numerous towards thetermination of the ileum. The stomachwas also highly innamed, and in the in..testines was found a moderate quantityof the same kind of fluid as that whichhad been passed a day or two previousto her dissofution. The membrane andsubstance of the brain were in a naturalstate.The following are the particulars

of the case : Mary Head, aged 19, stated,on -her admission, that a week previouslyshe had been seized with shivering fol-’ lowed by heat, ’and a violent pain in thehead.. The latter symptom had conti-nuedever since, but in a less degree,with delirium at night. On the day shecame to the Hospital, she complained ofpain on pressure at the pit of the stomach,and was labouring under general febrilesymptoms of rather an aggravated form.Pulse frequent, 140. Eight leeches to theseat of the pain, and the same number tothe forehead, and the compound chalkpill, with mercury,* every six hours; milkdiet.

14tb. Has passed a eomfortaMe night,and the pain is entirely gone; great pros-tration of strength ; anxiety of breathingand cough; bowels open twice; pulsefeehle, 122.

15th. The abdomen is tense, but com-plains of no pain on pressure; tonguecoated and red at the edges; respira-tion easier and cough less troublesome;pulse, 126,Omit the pills, and let her take two

grains of calomel, and two of antimonialpowder, every six hours.

16th. In the early part of the nightshe moaned considerably, but on thebowels acting freely she appeared easier;tongue dry and brown ; experiences nopain on pressure over any part of theabdomen ; pulse much firmer than yes-

* It was in this form that mercury wasfirst ordered for prisoners in the Peniten-tiary. It is composed as follows :—Take Dover’s powder, quicksilver withchalk, of each two and a half grains.

terday, 120 ; ordered to take half anounce of castor oil, with five drops oftandanum, and to repeat the former pills’;fomentation to the abdomen.

17th, 18th, 19th. The oil was repeatedtwice, but without the iaudanom; the

torgne has become moist, and upon thewhole she is improved ; the fomentationsand pills to be repeated.

20th. Tongne again dry; has passedseveral loose offensive stools throughthe night of a very dark colonr; breath.

ing very anxious ; pulse small and com-pressible, 106. ,

21st. Pain and purging have cease4;repeat the pills, and ordered to have sixleeches to the abdomen, and afterwardstomentations.

22d. Tongue moist, and bo,vels ,col1.stipated ; pulse firmer, 107; slight heatof surface. Calomel, one grain ; jaiap,five grains ; to be taken directly, and re-peated at night if requisite.23d. Feels better; bowels open once;

no pain in the abdomen; pulse, 92; adrachm of the s*tilpliate of magnesia incamphor mixture, to be taken three timesa-day.

24th. Last night bleeding took placefrom the nose, and she has lost about an

ounce altogether. The urine voided afew minntes since resembles in appear-ance strong senna tea; complains of nopain ; pulse frequent, 112.

25th. More beemorrhage ; has lost a

pint since yesterray morning; three orfour thin black stools have been voided,and the urine continues of the same co-lour as the former ; tongue dark and dry;pulse fluttering, 116; ordered strongbroth ; and to omit the medicine.

26th. Has lost another half pint ofblood ; stools and urine as yesterday;pulse, 126. She was delirious all night;calomel 10 grains, opium one and a-halfgrains, immediately; to take comp. suiph.aether in camphor julep every hour, andto continue the fomentations.She continued, however, gradually

sinking till the following morning, whenshe died.

Case ’of Neerosis.J. Blackwell, a fine, ftond child, nhe

years old, had been accustomed to assisthis parents in making bricks. One even-ing, in the early part of the month ofMay, shortly after his return home withhis father from work, llè suddenly com-plained of an excruciating pain in hisright leg, which was soon followed by anenlargement of the parts along the conrseof the bone. On the third day after theattack he was brought to the Hospital,

431

and admitted under the care of Mr. Law-rence. At this time a rather violent, butsomewhat circumscribed, inflammationwas observable on the anterior surface ofthe limb, accompanied with very acutepain. In a few days subsequent to hisadmission four abscesses had formed,which were opened, and nearly half apint of ill-conditioned matter escaped.The pain now became much less. Thelimb was treated with poultices, and anissne was afterwards made in the upperand back part of the leg, and kept openfor near two months. The inflam-mation continued for some time after theabscesses were punctured, but was even-tually subdued.In the early part of July, such extensive

erysipelatous inflammation attacked thelimb as to threaten the life of the patient,requiring the most active and vigorousmeasnres for its removal ; the child’shealth now became necessarily much im-paired, and it is only within a short timethat he has completely recovered it. Forsome weeks past he has taken his foodwith a good appetite. The abscesses’never closed, but degenerated into smallfistnlous sores, sometimes discharging athin sanies, at other times matter of amore purulent kind. Corresponding tothese fistulous sores were apertures inthe new osseous shell, and consequently,by means of a probe the sequestrum wasvery easily distinguishable; it was, we

believe, from the circumstance that themiddle portion of this sequestrum wasfound to be superficial, while the ends, oredges, were overlapped by the new bone,that the operation was deemed expedient.On Saturday Mr. Lawrence had the boyremoved to the operating theatre and ’,performed

’

The Operation.He commenced by making a longitu-

dinal incision about seven inches in extentover the most superficial part of the tibia,and this included three of the fistulousopenings ; the other being situated lowerdown and more on the inner side ; a trans-verse incision was next made across thecentre of the other to the extent of aboutfour inches, and the four triangular flapsdissected back. The external surface ofthe bone being thus exposed, a longitudi-nal aperture was with some difficultymade through it, (with one of Hey’ssaws,) of sufficient extent to admit theinsinuation of an elevator. A portion ofthe external surface of the bone was thenbroken off, and the piece of dead bonebecame exposed, this was taken hold of

’by a pair of pincers and with some diffi-cuity withdrawn. 14 was a very thin sheil,

ragged at the edges, and about one and ahalf inches in length. To call it seques-trum, perhaps, would not be strictly cor-rect, since it was found to be adherent tothe internal surface of the new bone. Itwas not thought proper to open the otherorifice on the’inner side of the leg, as itwas considered the small bit of dead bonecorresponding to it would soon be ab-sorbed. The parts being carefully sponged,the integuments were brought looselytogether by straps of adhesive plaster,and a little simple dressing applied overit ; up to the time of closing our reportthe little boy has gone on remarkablywell.

Amongst the persons lately admittedwith accidents, was Joseph Wessels witha fracture of the patella. This individualwas formerly a pupil to the late Mr. Ro-binson, was afterwards a dresser to Mr.Pitt, and subsequently became house

surgeon of this Hospital, succeeding agentleman by the name of Pennington,then house surgeon to Mr. Pott. In theearly part of his life lie went abroad, andeventually settled in Jamaica. Someprofessional business calling him to Car-thagena, he went there, and was on hisreturn when the vessel fell in with a pi-ratical schooner and was captured. Thecrew and himself were landed on a bar-ren part of the coast of Mexico ; andafter experiencing many privations, theyat length reached a small town in the possession of the " Patriot army," which theyjoined. After encountering many hard-ships and battles, he was at length takenprisoner by the Royalists, and sent toVera Cruz, where he was sentenced toeight years’ close confinement in a dun-

geon. As might be expected, a fewmonths of such confinement was sufficientto occasion alarming disease, and as afavour he got removed to the.hospital.The physician, learning his misfortunes,had a letter secretly conveyed to CaptainDunn, of the Rifleman sloop of war, whothe next day demanded him to be givenup. He now returned to Jamaica again,and, after collecting his little propertytogether, had embarked on his return toEngland, when the vessel was overtakenby the late hurricane and completely lost.After floating on the wreck for two days,they were picked up by an Americanvessel and earned to South Carolina,whence he proceeded to New York,and was sent home by our consul as adistressed subject. The surgeons andpupils of this Hospital have kindLy

presented him with a few pounds. Ali

he had been a medical pupil to our pr-

432

sent senior physician, Dr. Roberts, thestudents solicited his donation, when, onbeing asked wliat he would be pleased togive, the Doctor magnanimously replied-"nothink ! ! "

ST. GEORGE’S HOSPITAL.

Case of Injury of the Head.I. Awbrey, aged 26, a labourer, was

admitted into the Hospital October 21,under the care of Mr. Keate. It wasstated that he had fallen down a stair-case whilst -in a state of intoxication,when discovered he was found to be per-fectly senseless, and remained in thatstate till brought here, which was abouthalf an hour after the accident. Whenadmitted into the Hospital there wasfound to be an extensive lacerated woundof the scalp, over the lamdoidal sutme ;’the bone, however, was not denuded.The patient had stertorous breathing;the pupils were dilated and not obedientto the stimulus of light ; there was anentire loss of voluntary motion ; pulselabouring and irregular; the surface, butmore especially the extremities, were ofa low temperature. It was resolved towait until re-action had taken place. Thewound of the scalp was dressed with ad-hesive straps, and the patient put to bed.The spirit lotion to be applied to the head.10 o’clock a.m., slight re-action has takenplace, the temperature has increased,and the patient has vomited twice ; pu-pils still dilated ; still insensible; eighteenounces of blood to be taken from the

temporal artery, and -a dose of house

physic to be administered..

27. This morning we found that all thebad symptoms that were present yester-day had disappeared. The patient per-fectly sensible, and expressing himself asbeing free from pain or headach ; pnpilsact naturally ; pulse 100 ; tongue slightlyfurred ; the medicine taken yesterdayhas not operated ; he was directed to bebled to xij., a linseed meal poultice tobe applied to the head, and to take thefollowing draught every four hours :

Infusion of roses, iss.Sulphate magnesia, one drachm.

28. Has passed but a very indifferentnight. There is great pain and tender-Bess all over the scalp, which is of a hightemperature ; the patient is very restlessand feverish, and compJains of giddinessand great thirst; tongue dry and parched;pulse 110, full and strong, bowels freelyopen ; the saline draught with the ad-dition of a scruple of epsom salts andhalf a drachm of antimouial wine, to be i

taken every three or four hours, and re-peat the bleeding to xij.

29. In consequence of the symptomshaving increased, and which still remain,(namely, pain in the head accompaniedwith delirium,) it was necessary to repeatthe bleeding yesterday evening to 3viij, ;the pulse is still full and jeking; tonguedry and furred ; great thirst ; ordered tocontinue the saline draught, and to re-peat the bleeding to 3xiv.

30. Much relieved; pain in the headand the delirium have subsided, and heslept well in the night; the wound dis-charges freely, and there is less puffinessof the scalp; pulse, 80; tongue moist;less thirst; repeat the medicine.

31. Not so well as yesterday; erysipe-las has attacked the face, which appearsto be rapidly spreading down the neck;the wound of the scalp has a glossv ap.pearance, and the discharge, which be-tbre was healthy, is now thin and offen.sive ; pulse sott and weak; tongue lessfurred ; the saline traught to be discon.tinued. Infusion of bark, an ounce auda half; aromatic confection, one scruple;to be taken every four hours ; calomel,three grains, rhubarb, ten grains; to betaken in the morning; ordered full diet,with porter.Nov. 1. Did not sleep well; complains

of pain in the head ; great puffiness of thewhole scalp ; erysipelas with vesicationsof the face and neck ; pulse weak, andirregular ; bowels have been freely open.

2. Rather better ; pulse, 120, ex-

tremely weak ; says that he has less painin the head, and there is less puffiness ofthe scalp ; erysipelas does not seem tospread any farther. He was orderedfour ounces of port wine daily, with beeftea and arrow root.

3. Passed a very comfortable night;pulse, 94, and moderately firm; tonguedry and furred; bowels have not actedsince yesterday ; the skin is dry auti hot,and the patient complains of great thirst.He was directed to take ten grains of thecompound ext. coloc. at bed-time, and letthree drachms of the liq. ammon. acet. beadded to each dose of the bark.

7. Going on well; wound of the scalplooks healthy, and is fast healing; ei-ysi-pelas disappearing with desquamation ofthe cuticle; ordered to continue the me-dicine.

10. Continues to recover; he 11th andappetite greatly improved ; erysipelashas entirely gone off; wound of the scalpnearly healed ; pulse, 64. The formerdraught to be omitted ; and to take anounce and a half of the infusion of bark,with twenty drops of diluted sulphuricacid, three times a-day.