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ing skin very much inflamed;a poultice was put over the partto lessen the irritation. She canmove her legs much better thanyesterday, and draw them a littletowards her ; she can bend alsothe figgers of her left hand. Shesaid she could now turn herselfa little in bed, which the nurse Ialso corroborated.

5th.—The power of movingthe lower extremities continue:to increase. She can move hethand more than she could yes-terday : she has now very littlefever, but says she has pain inthe lower part of her back.-Hirudines decem supra sacrumapplic. Pil Hydr. gr. v. bisdie, Mist. Camph. c Carb. Po-tassœ 3 ss to be taken with le-mon-iuice everv six hours.6th.--The pain she complained

ed of yesterday has been remov-ed by the leeches. She can

move her lower extremities withgreat freedom, and can bend theleft arm and rotate it also. Her

pulse is 80 and soft ; her skincool ; she can move her trunkbetter ; but the urine still passesinvoluntary. We shall continuethis interesting case in our next.

The accidents received thuweek are :—Laceration of theinteguments just over the inner

’

cahthus of the eve. Retentionof urine. A slight case of con-cussion. Inflammation of the

conjunctiva and skin of thecheek with ulcer of the cornea.A contusion of the ancle. Ano-ther case of concussion. A verybad case of extravasation of

urine. A fracture of the tibia.No operations of consequencehave been performed here thisweek.

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ST. THOMAS’S HOSPITAL.

CLINICAL LECTURES

JUNE 30.-The cases which Ishall give you to-day, said Mr.TYRRELL contain several inte-resting- particulars, and I shallmake some remarks on them asI proceed.The first case is that of M. H.

aged 23, light hair, and ratherfair complexion, she was ad-mitted into Magdalen with go-norrhoea and excoriation of thelabia. She had lived at Graves-end as a fille de joie, for about a

year before she came to the Hos-pital, and in consequence of hervery irregular life, the generalhealth had very much suffered.She laboured under g-onorrhcea.at the time of her admission.-The gonorrhœa was soon gotrid of by the copaiba mixture.As the gonorrhœa got well, shecomplained of a sore on her legbeing* very painful, and whichthe usual remedies did not re-lieve. Considering that therewas something* in the atmos-

phere of the place prejudicialto her health, I ordered her tobe removed into a clean ward,the state of her system was care-fully attended to; she was al-lowed a generous diet and por-ter : the same remedies were

applied as when in the foulward,. and she soon got well.As she was about to be dis-

charged, the ulceration of theleg occurred again, with greatpain and tumefaction about thepart, and this was just at thetime the menstrual dischargeshould have appeared. She was

57

soon after attacked with iritis inone eye; when the former treat-ment was immediately given up,and from the violence of its at-tack, I was obliged to use moremercury than is generally neces-sary to cure this disease. Onthis part of the treatment I shallhave to say something more pre-sently. This case shows thatthe mercurial treatment which isnecessary ’to cure the venerealdisease, either from the breathof the patients, or some othercause with which we are at pre-sent unacquainted, produces abad state of the atmospherewhich operates unfavourably oncertain constitutions. The re-moval of the girl into a cleanward.and the use of the samemedicines, and the continuanceof the same diet, will, I thinkshow that this is the case. It’

shows also, another interestingcircumstance, viz. that the effortsof nature, set up to relieve the

system through the uterine se-cretion, exerted their iniluenceon the diseased part, -and pro-duced an imperfect substitutefor the natural discharge. Thisalteration in the state of theulcer has occured reneatedlv atthe time just mentioned, and thedischarge from the wound hasthen been of a bloody saniousdescription, although healthy

pus was before secreted.I The introduction of this case

of iritis, has afforded me an op-portunity of making a few re-marks on this disease. This wassimple iritis, marked by dimnessof vision, deep seated pain inthe globe and about the brow,by the zone of red vessels onthe fore part of the sclerotic coatpassing- in straight lines to-

wards the cornea,, by the green-ish tint of the iris, by the irre-gularity of the pupil, and by thedulness of the c6rnea and

aqueous humour. She took gr.iij of calom. and 3 gr. of opiumevery six hours, until the inflam-mation gave way. Belladonna.was applied to the brows imme-diatelv on the commencementof the treatment, and here alsothe case is important, as it showsthat if the belladonna had notbeen used, the vision would havebeen lost, for before we couldget the system affected, a largetubercle of lymph was depositedon the edge of the pupil, andwould have been almost largeenough to block up the pupil ifof its natural size; but as thebelladonna had dilated it largely,the sight was very little injuredby the size of the tubercle. Therewas a case analogous to this,in George’s ward, a little timesince, in which during an attackof iritis, as many as eight or tenpoints of adhesion had formed ’’and if they had not taken placein the dilated state of the pupil,vision would have been destroyedaltogether. There has beensome difference of opinion as tothe treatment of iritis. but mer-

cury is a decided specific. It isas frequently idiopathic as syphilitic ; when it occurs with -syphilis it is generally with thesecondary form of that disease,with eruptions, &c.

In the treatment of iritis, ifthe pupil should be even filledwith lymph before the patientcomes to you, if the deposit berecent, you need not despair ofof restoring vision. I lately saw

, a case of this kind, recover suf-ficiently to read a newspaper.—

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It was attended with secondaryeruptions, 1 gave calomel gr. v.and opium ¼ of a grain everyfour hours, and used the bella-donna;, immediately, the mouthbecame affected, the absorptionof the* lymph began and conti-nued rapidly. If the disease benot checked when the effusionof lymph takes place, pus willbe deposited in it, and you willhave an abscess form in the iris.This happened lately in a pa-tient of mine, the pus was effusedinto’ the anterior chamber, theutcerative process took place inthe iris, and a good artificial

pupil was left instead of thenatural one which had beenobliterated.

’

There is a form of iritis whichis never very acute, and it is ne-cessary to be-able to distinguishthis disease., as it produces as

much mischief, if neglected asthe other. It is curable also bymercury. There is no line ofvessels in the sclerotic, nor isthere any other appearance ofinflammation, but the pupil is ir-regular and slightly altered in

figure ; and you und, on dilatingit with Belladonna, that adhe-sions have taken place betweenit and the anterior capsule of theloiis. These adhesions form themost certain diagnostic markfrom amaurosis, or impaired vi-sion, with which it is mostlia-ble to be confounded. But acourse of mercury in Iritis wouldhave a decided influence on thedisease in five or six weeks. Animprovement in the state of vi-sion takes place almost imme-diately that the mercury affectsthe system. If the symptoms donot give way so soon, you shouldcontinue its influence, even to

the extent of two or threemonths.

The next is an interestingcase of sloughing chancre.—J.B., aged 24, of rather a sallowcomplexion, and dark hair wasadmitted into .one of the foulwards, June 10, with sloughingchancre. He had lived in apublic house as a waiter, andwas in the habit. of drinking’freely, and from his occupationwas obliged to beuplateatnightjhis appetite was bad ; he wasirritable and slept little. Aboutthree weeks before his admissionhe had chancre,which discharg-ed a thin g’leety matter; the soreincreased rapidly in size, the

prepuce became very much in--flamed, and it gradually slough-ed. When he came into theHouse the prepuce had slough-ed back to the corona glandis,and there was an offensive ill-conditioned discharge from thepart. He had a bubo also in theright groin. He was orderedhouse physic occasionally, andtook gr. v. ext. hyoscy. everynight, with the view of allyingthe constitutional irritation; andthe 1-iq. calcis, with mucilageand opium, which is a very excellent application to irritablesores, on lint, was used, andover the whole a light poulticeto keep, the lint moist. In aboutfive days, a healthy granulatingsurface appeared ; the chancrehas continued to heal rapidly-A blister was applied to thebubo, but it has since suppurated.It appears in numerous cases,that when sloughing commencesimmediately after infection, thereis no necessity to employ mer-cury, as the virus spends its vio-

59

lence upon the part, -and doesnot communicate the contagionto the system. In an interestingpaper, published by Dr. Gregoryof the small Pox Hospital, het as shown by numerous exaiii-

ples, that if the inflammatory ac-tion, succeeding the inoculation-take on the sloughing’ process,the constitution is not affected

by that inoculation, and - is

again susceptible of the disease.I have never seen a case of se-condary symptoms following’ aslonghing chancre ; and I haveseen more than twelve patientswith such chancres, and havewatched them for more than ayear afterwards.

The case ofE. F. was given,which was that of a larg’e chro-nic abscess, which formed be-tween the occiput and secouddorsal vertebra; there was somedifficulty, Mr. T. remarked, in

ascertaining’ this disease; thetumour was not well defined,the history of it was not thatwhich threw any light on thecase; the situation was not theusual one for these swellings.There was an indistinct tiuctua-tion in the tumour ; an incisionwas made into it, and six ouncesof pus discharged. The mostcoinmon seat of chronic abscessis under the fascia lata, somc--

times in the mamma and testicle,and occasionally in the bones.They usually form after fevers,or from exposure to cold whilstthe patient is in a - debilitatedstate, and most commonly instrumous habits. It is necessarywhen you determine on the ex-istence of a chronic abscess inthe thigh, to make an earlyopening into it, because the

fascaa lata is loosely connectedto the surrounding’ parts, andthe abscess rapidly spreads.--- -,

The fascia takes on the ulcera-tive process slowly, and there-fore the matter burrows in thestructures beneath it. The

integuments appear healthy, andthere is an absence of the

symptoms usually attending theformation of matter.

Occasionally they form overthe course of arteries, apd there-fore they are to be examinedcarefully. A case occurred in

Henry’s ward, last summer,which shews the necessity, ofinvestigation. I admitted a manon the Thursday, with a largetumour in the ham, extendinground by the knee. The integu-ments were a little discoloured,and he had some symptomswhich attend the formation ofmatter. The man could give avery imperfect history of, hiscase, but be said it came like ahard lump in his ham, and hadbeen gradually increasing. Hehad fever and frequent sh-iver-ings. On examining the mancarefully the next day, when Isaw the patients taken in, Ithought I could distinguish a

diffused pulsatory feeling in the.tumor; I concluded that it mustbe an aneurism in its advancedstage, and aslied the patientsome further questions, whichconfirmed me in the opinion.As the integuments were dis-colored from the pressure of thetumor., I considered it necessaryfor something to be immediatelydone, and the case being rathera doubtful one to some persons,I desired Mr. GREEN and Mr.KEY to examine the tumor, andthey both came to a different con-

clusion, and agreed that it wasan abscess, and thought thesafest plan would be to puncturethe tumor, which was accord-

ingly done, when a stream offlorid blood gushed out. Theartery was immediately securedby a ligature about the middleof, the thigh, which separatedt the "usual time. The slough- I,ing process commenced a few I,weeks after the operation, in thefoot; and gradually extended

up the leg; the man sunk underthe immense discharge and con-stitutional irritation. On dissec-tion of the body, two aneurismswere found in the thigh of thesame side, one at the tendon ofthe triceps; and another muchsmaller, a little above- the midaleof the thigh, and it was here

- the ligature was obliged to beapplied. Three aneurisms werefound in the other thigh.

Mr. T. concluded his lecture;by making some very useful ob-servations on simple ulcers, onulcers about the malleolus in-ternus, arising from a varicosestate of the veins, and on sino us ul-cers; he gave the treatment foundmost successful in -the differentconditions of the various ulcers,and hoped in his next lecture togive some good cases, of whichthere appeared a scarcity in thehouse at present.

ERRATUM—In our last report, "forDr. Fane read Dr. Farre."

The principal accidents ad-mitted here, are a fracture 4)fthe as femoris, about one thirdthe length of the bone abovethe knee; a. laceration of thescalp; a contusion of the muscu-lar part of the legs the blow

was received on two points, onthe upper part of the belly ofthe gastrocnemius, and aboutthree inches above the ancle.The man’s health had been pK-viously very much deranged andthe injury was speedily followedby extensive erysipelatous in-flammation, which has spreadto the groin of the same side,and there are large vesications’of the cuticle. The man is tak-ing gr.v. sulphate of quininewith gt. v. of the diluted sulph.acid in ij of water, every sixhours. A spirit wash is appliedover the parts; his bowels’hadbeen previously’ acted ’on bycalomel ; the pulse’ is ’rather.’

‘

weak, and the tongue muchfurred.

An accident seldom met with,was also brought in, and is nowin George’s ward. The man in

coming down stairs slipt, hisfoot, and in attempting to save

himself, he threw his trunk sud-denly backwards, and felt some-thing snap at his knee, and on: ’

,

reco vering his footing, he foundshe had No power over the leg.He was carried to the Hospital-,and it appears that he has rup-tured the tendon of the rectus,the patella is in its situation, its-figure is perfect, but there is aihoilow.just above it, into whichthe finger readily sinks, and a:defined firm surface can be feltjust above the, hollow, but it hasnot the hardness of,bone. The:leg is secured just in the same.way as in the fracture of thepatella.The only operation performed

is the paracentesis abdominis, byMr. TYRRELL