153

ST. BARTHOLOMEW’S HOSPITAL.

There is now in Sitwell ward a female patient, under thecare of Mr. Stanley, affected with a cutaneous disease whichhardly finds a place in the recognised classes of cutaneousdisorders. Her right leg, from the foot up to near Poupart’sligament, is covered with scars of the size of a half-crown,and these are all the result of a successive and spontaneousdeath of a circular patch of skin, which at first takes onmilky whiteness, then shrivels and falls, and leaves an ulcer,which, on healing, forms a cicatrix. Mr. Archer, the house-surgeon, informed us that this patient has been in the hospitaltwice before; these strange patches were first limited to alittle above the ankle, and a circular line made by nitrate ofsilver stopped their progress. She went out, and returnedsome time after with a patch just overstepping the boundaryline, the leg presenting a good deal of redness and tumefac-tion ; the nitrate of silver was tried again, and the upwardprogress of the patches was again stopped, and preventedfrom ascending higher than a little above the knee, when shewas discharged. She is now in the ward for the third time,and both Mr. Stanley and Mr. Lawrence expressed themselvessurprised at this unwonted appearance. An idea had beenentertained that the woman was practising a deception, but itwas soon abandoned. She is about forty years of age, and thetreatment has consisted principally in the administration of ,,

iodide of potassium; now, however, she is taking Fowler’ssolution of arsenic. A fact well worthy of being noted is theevident control the arsenic seems to possess over this strangecutaneous manifestation. Some days ago Fowler’s solutionwas suspended for a little while, and the formation of newpatches, which had been stopped for some time, resumed itsactivity. The medicine is now being administered in graduallyincreasing doses.

THE MEDICAL WARDS OF ST. GEORGE’S HOSPITAL.

A very interesting summary of the cases admitted into themedical wards of St. George’s Hospital has been drawn up bythe medical registrar. We wish to direct the attention ofour readers to this document, principally in order to set forththe proportion of sexes with respect to certain diseases, andoccasionally the age of the patients, the average time taken upby the cure, and the mortality. Though details are not in thenature of such a synopsis, and treatment is not touched upon,since the summary was especially addressed to the governorsof the hospital, our analysis will not be wanting in data ofgreat statistical usefulness.

Dr. Barclay, the medical registrar, has adopted the plan ofthe registrar-general, and has thereby secured great distinct-ness, and tables of easy reference. He has, however, beenable, by working on a smaller scale, to give more details thanare to be found in the weekly tables. The patients are, foreach class of diseases, divided in males and females; there areseven decennial periods from 0 to 60 years and upwards,instead of 0 to 15, 15 to 60, and 60 and upwards, of the weeklytables. The great divisions are twelve :-First class: zymoticdiseases, (viz., those which are supposed to owe their origin toa ferment,) as measles, scarlatina, diarrhoea, dysentery, purpura,ague, and fever. Of these, it will be interesting to glance atsccarlatina. If we take the word cured in its strictest sense,we sliall fiud the mortality unusually low, for out of eightmales only one died, and out of eight females only two died.Of these eight females, three were between thirty and thirty-nine years of age, the rest, of course, all younger; those whodied eLlaired within three days of their admission, and themaximum stay in hospital for the cures was 63 days. The

summary cannot enter into details, but it may be supposedthat the rapidly fatal cases were attacks of scarlatina anginosa,and a very useful addition would have been to say how manysuffered the dropsical sequelae. If we turn to fever, we find agreat disproportion of sexes in the common form-viz., 38men and 73 women; whilst in the spotted variety the matteris reversed, 35 men and 24 women. But on fever, Dr. Bar-clay has himself made some remarks, which we shall giveon a future occasion. The second class are the diseasesof uncertain and variable seat; here we find general dropsy,cachexia and debility, and hysteria and chlorosis; of thelatter, the large number of 11 were admitted, of which64 were cured, the rest relieved, or left while under treat-ment; as to age, we remark that three were between 4Cand 49. The third class comprises tuberculous diseases,and here we are surprised to find 62 males and oaly32, females under the head of phthisis. Are females oithe better classes more liable to phthisis than those who resortto hospitals ! Fourlh class.- diseases of brain, spinal marrow;

nerves and senses, subdivided into apoplexy, paralysis, deli-rium tremens, chorea, epilepsy, inflammation, and other affec-tions of the brain. In all these the males predominate, exceptin chorea and epilepsy. The statistics of paralysis are eversad; out of 21 men three were cured, and 18 relieved; out ofthe twelve choreic females five were cured; only three maleswere admitted for that disease, and they were but relieved;in inflammation of the brain, &c., &c., there are 39 malesagainst 19 females; and the fact of acute inflammation beingoften amenable to resolution, and complete cure, or greatamendment, is shown by 11 cures, and 14 cases of relief, putagainst the 39 males. Fifth class: diseases of the heart; herethe sexes stand very close, 38 males and 36 females; and wefind, as might be expected, merely relief afforded to 18 men,all the rest but one died; the proportion of deaths was notquite so great with females, 22 relieved, and 14 deaths. Sixthclass: diseases of the lungs-pneumonia, pleurisy, and bron-chitis. In all these three, the males are far above the females;in pneumonia, for instance, 16 men and seven women. Of themen, seven died; of the women, two. Seventh class: diseasesof organs of digestion—cynanche, peritonitis, hsematemesis,ascites, jaundice, and other affections of the liver, colica Pic-tonum, affection of the stomach and bowels. In nearly allthese, except in colica Pictonum and ascites, the women pre-dominate. Of course, no strict deductions can be drawn fromascites, and affections of the stomach and bowels, though Dr.Barclay has added the various complications in notes of refer-ence; still, it is useful to notice, that the largest amount ofcases of affection of the bowels occurred between the ages of20 and 29; namely, 23 females out of a total of 48. Eighthclass: diseases of the kidney-diabetes, affection of the kidneyand bladder. Only one diabetic patient was admitted throughthe whole year; this seems strange, as the proportion isusually somewhat larger in hospitals. Dr. Barclay mentions,in a note, that besides the 22 males and 20 females whosuffered from diseased kidney, nine other cases existed in thehospital as complications of other diseases. Ninth class:diseases of uterus and ovaries-ovarian tumours, cancer, otheraffections of the uterus. Out of 13 women affected with ova·

rian tumours, 10 died. Tenth class: rheumatism-subdividedinto acute rheumatism, sub-acute and chronic rheumatism,gout. Here the males predominate largely, being, in chronicrheumatism, 113 males to 61 females. Of the males, 61 werecured; of the females, 29. In gout, there were 10 males andtwo females. Eleventh class: skin diseases, I males and 21females. No indication as to the number of cures. Six casesof poisoning occurred, all women; the substances used were,in two, oxalic acid; one, sulphuric acid; two, laudanum; one,white precipitate.-All the six were cured.

LONDON HOSPITAL.

Fracture of the Spine.—An organ of a delicate texture andessential to life is exposed to injury by fractures or displace-ments of the spine, and this injury gives rise to various symp-toms which lead very frequently to a fatal issue. Still theparalysis and anaesthesia, may vary in degree and extent, thedeath of the patient may be more or less rapid, and the lesionsof the cord may be of different kinds-as concussion, compres-sion, laceration, inflammation, extravasation, and softening.Now it can be but very useful, both as regards diagnosis, pro-gnosis, and treatment, that the connexion between these va.rious circumstances should be studied in individual cases; forby becoming acquainted with the true chain of cause and effectwe shall be able to devise, with more satisfaction, means ofreduction and extension, which, in favourable cases, may savethe sufferer’s life. Mr. Luke had very lately under his care a-labourer at the Docks, who sustained a fracture of the spinein the cervical region, which proved fatal, though not iiistan-staneously, as the injury was situated below the origin of thephrenic nerves. It would appear, from the details with whichwe were kindly furnished by Mr. Millar, the dresser, that thepatient was struck on the chest by fifteen hundred-weight ofcoal, the back of his neck coming in violent contact withthe side of the ship. When brought in, he was in a state-of partial collapse, from which the usual means roused him,.when it was found that he complained of much pain towardsthe sixth and seventh cervical vertebrae, in which region anunnatural prominence was discovered, the shoulders being, atthe same time, drawn backwards as by a violent contractionof the trapezius. The paraplegic symptoms were at first con-fined to the legs, and partly to the arms; the intercostal andabdominal muscles acted but very feebly, the breathing beingdiaphragmatic, and the abdomen flapping at each expirationThe paralysis likewise affected the bladder; priapism was pre-sent,, and there was an emission of semen at the withdrawal of