159

AMPUTATION OF THE ARM BY MR. TRAVERS.

On Friday last, April 25, Mr. Travers re-moved the arm above the elbow, in conse-quence of severe injury to the elbow joint,comprising dislocation of the radius and ulnaforwards, and fracture of the olecranon at itsbase, with an extensive contused wound.The patient was a middle-aged sailor ; theaccident occurred on the 9th of April, and hewas admitted into the hospital on the samedav: attempts were made to save the limb,but the wound eventually presented a sloughyaspect, and the constitutional derangementbecame so considerable that an operation wasrendered imperative.

In the performance of the operation, therewas nothing remarkable, except that it wasexceedingly well executed.

GUY’S HOSPITAL.

CASE OF SIMULTANEOUS FRACTURE OF BOTH

PATELLÆ, RESULTING FROM THE ACTIONOF THE EXTENSOR MUSCLES.

JAMES MANSFIELD was admitted into Guy’sHospital on Sunday, April 20th, 1828, inconsequence of his having received the in-juries in question.The patient (of middle stature, and mus-

cular) stated, that on Wednesday, April16th, lie was wheeling a loaded barrow, thewheel of which became disengaged from itsplace, and he was suddenly thrown forwards.In an attempt to erect his body, to preventfalling upon his face, his knees cracked,and instantly bent under him, and he fell tothe ground. He was found to be incapableof rising, or of standing when raised; he was,in consequence, taken home, and put underthe care of a gentleman at Camberwell, atwhich place the accident happened. Con-siderable tumefaction followed the injury, anda great number of leeches were applied. Noattempt was made at the time to reduce thefractured bones, and on the fourth day afterthe accident he was conveyed to the Hos-pital. The dresser immediately adjustedthe patella straps, and under the use ofthese, the fractured portions were broughtas nearly into apposition as possible : thespirit wash was constantly applied. Thelimbs were laid on straight splints, the legswere extended, and the thighs were verymuch bent upon the body. The separa-tion of the fractured portions of the leftpatella was very trivial, whilst of the rightknee it it was very considerable. The pa-tient is, however, doing exceedingly well ’

23d. The tumefaction has very much sub-sided, and the fractured portions of the left

patella are in apposition. The effusion aboutthe right knee still remains to such an

extent, that the separate portions are aboutan inch asunder. The use of the spiritlotion has bren dispensed with in theleft knee, and is now only applied to theright. The thighs were a little more bent

upon the bodv, and the shoulders raised withpillows to flex the pelvis. To day he wasvisited by Sir Astley Cooper, who expressedhimself pleased with the manner in whichthe patient had been treated by the dresser.*

28. The patient is going on perfectly well.

OPERATION OF LITHOTOMY BY MR. KEY-

THE STRAIGHT STAFF.

The operation of lithotomy was performedby Mr. Key, on Tuesday last, upon a littleboy about three years of age, whose casewas briefly adverted to in our last Number.The instruments used on this occasion

were but three in number: the straightknife, straight staff, and straight forceps.The whole of the operation, however, wasnot quite straight.forward work ; the exter-nal incision was very fairly made ; the knifeafterwards carried onward, and the staffwithdrawn. Mr. Key then passed his fingerinto the wound, but after a slight and gentleexamination withdrew it, and having ascer-tained that he had not opened the bladder,he reintroduced the staff, and again puttinghis finger into the wound, carried the knifealong it, and made an incision downwardsand outwards. The forceps were introduced,and a calculus, of about the size of a nutmeg,extracted without difficulty.The operation was completed in about

two minutes ; Mr. Key, throughout, mani-festing the greatest coolness and self-pos-session ; we observed, however, that theblood momentarily’forsook his cheek, whenhe addressed the pupils after the operation,stating, that the staff, in the first instance,had slipped from the calculus, and that, inthe first incision, he had failed to open thebladder. ’

Mr. Key subsequently remarked, that thestaff was too short.

’

* Although it was the seventh day fromthe accident, the worthy baronet did not re-commend the parts to be freely moved ; hehas probably altered his views since the ca.lebrated 11 flint case." -

ST. GEORGE’S HOSPITAL.

OPERATION OF LITHOTOMY, BY MR. KEATE.

AIR. KEATE performed the operation oflithotomy, on Thursday the 24th, upon alittle boy. The bistouri cachee was used onthis occasion, and a calculus, of about the

size of a sparrow’s egg, was extracted ; theoperation was very dexterously performed,not more than one minute being occupied inaccomplishing it.

On the same day, Mr. Brodie ° did" theoperation of castration, also that of amputa-tion of the thigh, and of the leg ; in the for-mer case on account of scrofulous disease ofthe knee-joint, and, in the latter, for disease Iof the ancle.

CASE OF MR. ROBERT KEATE.

We are gratified in being enabled to statethat phlebotomising has had a most salutaryeffect in reducing the " constitutional irri-tation " of this little patient. The fits areless violent, and of shorter duration ; theserum of the blood withdrawn contained a

large portion of bile-there was but littlefirmness or solidity in the mass.

WESTMINSTER HOSPITAL.

STRANGULATED FEMORAL HERNIA, GAN-

GRENE, AND RUPTURE OF THE INTES-

TINES.

ANN CooKE, aetat. 55, was admitted intothis hospital on Thursday evening, April 24,with strangulated femoral hernia, whichhad been down for several days. Accord-ing to her statement, she has been subjectto hernia for the last ten years ; and, onThunday week, she was seized with violentsickness, coughing, &c., which continuedfor upwards of four hours, during whichtime she says, that she perceived the herniahad descended into her left groin, and wasgreatly increased in size. As soon as shewas admitted, Mr. Smith, the house-sur-

geon, had her placed in a warm bath, whichnot proving of any avail, Mr. Guthrie wassent for, and before his arrival another bathwas used, which did not prove more effectualthan the former. Mr. Guthrie saw her at

nine o’clock, and made use of the taxiswithout success ; considerable pressure hav-

ing been made upon the tumour, without

producing much pain, he deferred operating’that evening, observing that the symptomswere not very urgent.

April 2.5. Mr. Guthrie saw her at ninethis morning, and ordered her another bath,which did not prove of any more effect thanthe former. At twelve he saw her again,and performed the

Operation.Mr. Guthrie divided the integuments and

coats of the sac, in the usual manner ; therewas considerable difficulty, bowever, in find-ing the intestine ; when found, it was ob-

served to be of a very dark colour, owing, asthe operator stated, to mortification havingtaken place. After some careful, thou:..

tedious dissections, the stricture was d:.vided, and the intestine was returned : 3,fr.Guthrie then introduced his finger throughthe ring, but he hastily withdrew it, and alarge quantity of fœcal matter immediatelyescaped, to the no small discomfiture andamazement of the operator, who, addressingthe pupils, said He thought that he hadused too much force." After the operatiot,the patient felt herself much relieved.

26. She has slept very little, and has had- ; no motion per anum. A small quantity 0;’ffsBcal matter has escaped from the wound;pulse 88. She was ordered an enema, com-

posed of gruel and oleum ricini, every twohours. Tongue very much furred.x’7. Abdomen rather swollen and painful;

hirudines xviii. ordered to be applied to it;her pulse to day is 82 ; she has had sereralother motions per anum, and there is still atenderness ofthe abdomen, also a slight dis.charge through the wound.

28. Much the same as yesterday. Pulseabout 90.

29. The patient continues to go on verywell ; her pulse to-day is about 86. A lo.tion to be applied to the wound, composedof the chloride of soda ij.; water half a

pint.

EPIGRAM

On the Patient who suddenly decamped fromGuy’s Hospital, and passed onw to St.Thomas’s.*

Rash, thoughtless man! ah, whither dostthou flv !

If death appal thee, why such haste to die?

Bath, April 28th, 1828.

* Vide LANCET, No. 241, p. 49.

TO CORRESPONDENTS.

We shall insert Dr. MACKINTOSH’S communication ’ On the cause of the effusionin the disease termed hydrocephalus," inan early Number.The ungentlemanly and brutal coddtict of

a lecturer on anatomy, towards his house.pupils, deserves exposure.Other Correspondents in our next.