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ON A CASE OF ENCEPHALOCELE.
of blood from these, and what the peculiarity of the blood which prevented the arrest of bleeding in the usual way that Nature provides, must be left to the demonstration of future observers, and of such as may be afforded the opportunity of establishing the conditions by the aid of the microscope and ofchemistry. Certainly no recognised state of purpura or of haemorrhagic diathesis, or of mere menorrhagia, can suffice to explain the phenomena of this very interesting, anomalous, and melancholy case. The antecedents of the child’s history and appearance are not in accordance with any common or usual causes of a bleeding that was altogether rare and peculiar.
consisted of a serous fluid. The vomits were and of a thin, pale, sero-mucoid fluid; the cramps, which seemed to affect the whole muscular system, were rapid, powerful, and agonizing in their character. Suppression of urine had existed for fifteen hours. I gave immediately six drops of the arsenical solution, reo peated the dose in ten minutes, and again in twenty minuter more. Directly after swallowing the third dose, the patient, with a slender, tubular voice, ejaculated, " There, that will stay." He was right; it did stay, and from that moment the vomiting ceased. The arsenic was now repeated at intervals of half an hour. By-and-bye the cramps and purging ceased, 1857. Melcombe-place, Dorset-square, Sept. the sphincter ani recovered its power, warmth began to diffuse itself over the surface of the body, the pulse became steady, distinct, and numerable; and, at the end of two hours, I left ON THE VALUE OF ARSENIC IN CHOLERA. my patient in comparative safety. During the night the arsenic was continued in three-drop doses every third hour. BY C. BLACK, M.D. LOND., F.R.C.S., On the following morning I found that there had been no repeFELLOW OF THE IMPERIAL SOCIETY OF PHYSICIANS OF VIENNA, ETC. ETC. tition of either vomiting or purging, and that the renal secretion had been restored during the night. Two days afterwards he was able to leave his bed; but his convalescence was IT is now almost three years since I published, in a contem- marked by anasarca, the result of the action of the choleraic porary journal, a number of cases of the very worst form of poison on the vitality of the blood, and of the great diminution English cholera, in which I had obtained a rapid and effectual of its solid constituents by the copious evacuations which cure from the use of the liquor arsenicalis. Since that time I occurred during the urgency of the attack. Now, this case occurred in a dwelling which stood upon a have had ample opportunities of further testing the value of dead flat of ground, from three to four feet below the level of this remedy in cases of English cholera, presenting symptoms the contiguous road, which had consequently no fall for so severe that, had the Asiatic form of the disease been prevaand the cellar of which stood one or two feet deep in drainage, lent at the time, there would probably have been no hesitation water during rainy weather. Its occurrence arose after a in referring the cases in question to that particular type. In heavy fall of rain, and when the imperfect drains in question all these cases the arsenical treatment was followed by such emitted an almost intolerable smell. It is therefore fair to presume that it had its origin in some noxious emanation from rapid subsidence of the symptoms, and by such quick and com- the drains, with which the circumambient air became impregto that restoration I have been led to health, plete regard nated, and thus acquired the power of injuriously impressing arsenic in the light of a specific for cholera. living bodies. It is not in the milder forms of the disease, which are trace. ’7’0 destroy such a poison in the blood, I gare to the blood a able to disturbing injesta, that arsenic will be found beneficial; poison, which acted irr. accordance with a well-known physiobut in those severe and aggravated cases which occur in the logical law, and cured the disease. narrow alleys, badly drained, ill-ventilated dwellings, amidst I have done so in many such cases, in which the ordinary the filth, poverty, and squalid wretchedness of certain districts remedies for cholera had entirely failed, and I have itaaariably of most towns. found that the arsenic exerted a rapid power of control over In the absence of necessary sanitary measures, in the condi- the vomiting and purging, and quickly brought about a state tions favourable to the generation of animal and vegetable of convalescence. poisons, and in the presentation of foci from which the diffusion ’ From such data, then, I maintain the specific action of arsenic of such poisons may take place, Chesterfield is not surpassed, in the very worst form of English cholera, and I thence infer if equalled, by any other inland town of similar size within the for it a similar power in the malignant type of the disease. United Kingdom. It is a fact confirmatory of this remark, In the East, where at the present moment the tenure of our that at no time within the last twelve years has the town been Indian possessions depends on the maintenance of the health entirely free from typhoid fever; that this form of fever and of our soldiers, this dreadful scourge is decimating the heroic epidemic typhus ravage the place at intervals of one or two band under Havelock, and, unless speedily checked, may years; that here scarlatina assumes its malignant form; that possibly lose us an empire which has cost us so much blood and epidemic dysentery is not uncommon; and that during the treasure to win. Let the surgeons of the Indian army adopt. summer and early autumnal months the cases of cholera are this remedy--let them give it a fair and impartial trial-and I numerous, and many of them extremely severe. As an ex- feel confident that with them it will maintain the reputation. ample of the last-mentioned disease, I detail the following case, of a specific for cholera, which I here accord to it. which occurred in my practice in August last, and which, as The instructions for its use are simple and precise. For the one amongst many such, shows alike the character of cholera Asiatic cholera, ten or fifteen drops in cold water, every ten or as it occurs in Chesterfield and its neighbourhood, and the fifteen minutes, until vomiting and purging abate, and then, value of arsenic as a remedial agent :smaller doses, at more distant intervals, until reaction is estaJ. P-,aged forty-two, by trade a master potter, was blished. seized on August 13th of the present year with violent vomiting Chesterfield, September, 1857. and purging, accompanied by frequently-recurring pains in the abdomen, and by general collapse. The dejections were thin, watery, somewhat offensive in odour, and contained a moderate ON A proportion of bile. The vomits consisted of food previously taken, with certain admixture of a thin mucoid fluid. CASE OF ENCEPHALOCELE. These symptoms were combatted by lead and opium, chalk BY ROBERT U. WEST, M.D., Alford, Lincolnshire. mixture with catechu, friction, the application of external heat to the extremities, sinapisms, and turpentine stoups to the MR. LAURENCE prefaces his account of a case of encephalo· abdomen, and by weak cold brandy-and-water to drink. exhibition and the of these remecele, in THE LANCET of Sept. 5th, with speaking of the pnblidiligent application Despite dies, the symptoms increased in severity from hour to hour. cation of a previous case, in which he says he gave a résumé of In the morning of the following day, I received an urgent mes- all the cases recorded up to this his present case. Mr. Laurence sage to attend immediately, as, in the opinion of his friends, the patient would die. On arriving at his home, I found him may add the following case to his résumé. I did not publish in the greatest collapse, with countenance pale, livid, and of a it at the time it occurred. leaden hue; eyes glassy and sunken in their orbits; nose May 29th, 1851.--Mrs. B-, of L-, near Alford, was nipped; tongue pale and besmeared with a thin layer of mucus; delivered, after an easy and perfectly natural labour, of a fullbreath cold; great thirst; skin cold and soddened, with a sized female child, which had a bag of integument of considerclammy perspiration ; voice reduced to a thin, slender, squeak- size hanging down the back from the occiput. This bag conwhich I suspected at once to ing note; pulse thready, running, and incapable of being num- tained fluid and a solid substance, bered. The dejections are involuntary, almost constant, left be brain, in consequence of feeling that a portion of the occiiif;tla nr nn eta.in upon thp bed-linen_ of a faint. sicklv odour. pital bone, in the centre of the expanded or "squamous" 11 por-
itself,
338
and
evidently
frequent,
tion, was wanting. I punctured the bag, and let tity, perhaps two ounces, of bloody serum. The
out
a quan child lived five weeks, and then died, with convulsive symptoms, and a the eyes. For the peculiar, old-looking, staring expression of suffer two or three weeks it appeared to considerably, though for the first fortnight of its life it seemed to thrive, sucking well, and with all the functions well performed. Shortly before its death, the discharge from the puncture became very offensive and purulent. On examination after death, I found the bag contained thE whole of the cerebellum, which was in a purulent and semi putrid state, the result of disease, which was almost a necessar3 consequence of its unprotected state. The skull, which con tained nothing but the cerebrum, was flatter and smaller thai
last
natural. This monstrosity may be regarded as the first stage of th deviation denominated by Geoffroy St. Hilaire, Notencephalie. September, 1857. ________________
A Mirror
attempt
IMPLICATION OF THE HIP-JOINT.
OF THE PRACTICE OF
MEDICINE AND
to save the limb, as the circumstances of the age, constitutional condition, and freedom from intemperance, gave hope of good result. The supinator and long extensor were removed from their tendons, the dislocation reduced, and the forearm placed on a splint; the edges of the wound were gently approximated by strips of wet lint. Little constitutional excitement ensued, and he made rapid progress towards a cure. At the end of a week, there was considerable suppuration, and he was ordered a bread poultice and good diet, including eight ounces of wine. Under the use of nitrate of silver lotion, and oxide of zinc ointment, cicatrization occurred, and he was discharged from the hospital on July l4th. He has at this date (Sept. 22st) a large cicatrice extending the whole length of the forearm; the ulna is tilted upwards from the wrist; and there is scarcely any power of rotation from the forearm, or of extension of the wrist or fingers. Still his power of prehension is gradually increasing, and he is likely to acquire useful power over the hand. It is proposed to assist the extensors by a bracelet, to which is attached a spring to act on the palm of the hand, and so straighten the wrist.
cided to
patient’s
SURGERY
IN THE
HOSPITALS OF LONDON. Nulla est alia pro certo noseendi via, iisi quam plnrimas et morborum e1 dissectionum historms, tam aliorum proprias, eotlectas habere et inter se com. parare.-MORGAGNI. De Sed. et Caus. Morb. lib. 14. Procemium.
LONDON HOSPITAL. MOST EXTENSIVE LACERATION OF THE ENTIRE FOREARM, WITH COMPOUND FRACTURE AND DISLOCATION, THE RESULT OF AN INJURY; SOME OF THE MUSCLES TORN FROM THEIR ORIGINS, AND HANGING FROM THE WOUND; RECOVERY.
(Under the
care
of Mr. CURLING and Mr.
WORDSWORTH.)
IT is really astonishing sometimes to witness the recovery of Since the publication of Mr. Hancock’s very interesting case, patients who have suffered some very severe injury to one of their limbs, so severe and so gravethat very little thought is (THE LANCET, vol. i. 1857, p. 141,) in which that gentleman excised not only the head of the femur, but also the acetabulum requisite, on the part of the surgeon, to determine him to re- itself, we have seen excision of the hip-joint performed several move the member, the condition of which is looked upon as times with a very fair amount of success. And although a the reach conservative efforts to save of it. Under beyond any similar operation upon the knee has been done a far greater such circumstances, we maintain it requires no small amount number of times, yet as that joint has already had some attenof moral conrage to refrain from operative measures; and onr tion bestowed upon it in our Mirror," we purpose devoting a consideration to the hip-joint. principal source of encouragement to do so, is where the age little There can be no question whatever that the most suitable and constitution are otherwise favourable, as they proved to be cases for excision are those in which the head of the bone has in the following example. But a few years ago, this boy’s arm been lying out of its socket for some time, proving a source of would have been amputated as a matter of course, for al- constant irritation and annoyance, by keeping up an exhausting though the details of the case afford a tolerable view of the discharge, associated witch an utter impossibility of moving the as well as sometimes of movement of any kind whatsoinjury, its extent was such as to leave but little hope. had his limb, The position of the unfortunate subjects of exhausting ever. been health otherwise than favourable. Besides other previous disease must be familiar to Such hip-joint surgeon. lesions, some of the principal muscles of the forearm were I cases are the most suitable because theevery acetabulum has had actually torn from their origins, and hanging loose from the time to recover itself, and to become in many instances filled wound, being held by their tendinous attachments. This case up with a new material. Of the recent cases in which excision has been done, none struck us as more favourable for the operawe present as a typical example of what conservative surgery is doing in our hospitals; and it, moreover, well illustrates tion that Mr. Coote’s case, at St. Bartholomew’s, on Sept. 21st, as the head of the bone had been dislocated for some time, the the powers of the upper extremity in recovering from such discharge was not very great, the acetabulum was in a quiescent severe injuries. state, and the structures around the head of the bone were J. W. J-, aged fourteen, admitted April 11th, 1857, tolerably healthy. Sometimes the head of the bone lies imThe same morning, while bedded in pus, which infiltrates the neighbouring tissues, and under the care of Mr. Curling. drawing a truck, he accidentally came into collision with a the patient is much worn out with hectic. With even a greater amount of disease present than what sugar-van, the wheel of which passed over the right forearm, producing a compound fracture of the radius in its upper third, we have represented,-such as disease of the acetabulum more a compound dislocation of the ulna, from the triangular cartior less extensive, attended, perhaps, with actual perforation, lage at the wrist, and a very severe laceration of the integu- pelvicabscess, fistulae about the ischio-rectal fossae, &c.,-this ments and muscles, from the elbow to the wrist. The supi- operation may be done, not only with impunity, but with a nator longus and extensor carpi radialis longior were com- chance of success. They were all present in Mr. Hancock’s pletely severed from their origins, and hanging from the case already cited, in which, moreover, a probe could be passed wound by their tendons; the short radial extensor was partly through a fistulous opening in the groin into the pelvis, and divided; the bone was fractured, without comminution; the from thence out through an opening in the acetabulum. The ulna admitted of easy reduction; the skin, though greatly operation was successful, the whole carious floor of the lastlacerated and contused, was not absolutely destroyed; the named cavity, as well as the diseased head of the femur, being bloodvessels and nerves had escaped injury. In Mr. Curling’s removed. ’’
absence Mr. Wordsworth
was
called to
see
him.
It
was
de-
The recent rlnntrine that these diseased conditions which
339
consisted of a serous fluid. The vomits were and of a thin, pale, sero-mucoid fluid; the cramps, which seemed to affect the whole muscular system, were rapid, powerful, and agonizing in their character. Suppression of urine had existed for fifteen hours. I gave immediately six drops of the arsenical solution, reo peated the dose in ten minutes, and again in twenty minuter more. Directly after swallowing the third dose, the patient, with a slender, tubular voice, ejaculated, " There, that will stay." He was right; it did stay, and from that moment the vomiting ceased. The arsenic was now repeated at intervals of half an hour. By-and-bye the cramps and purging ceased, 1857. Melcombe-place, Dorset-square, Sept. the sphincter ani recovered its power, warmth began to diffuse itself over the surface of the body, the pulse became steady, distinct, and numerable; and, at the end of two hours, I left ON THE VALUE OF ARSENIC IN CHOLERA. my patient in comparative safety. During the night the arsenic was continued in three-drop doses every third hour. BY C. BLACK, M.D. LOND., F.R.C.S., On the following morning I found that there had been no repeFELLOW OF THE IMPERIAL SOCIETY OF PHYSICIANS OF VIENNA, ETC. ETC. tition of either vomiting or purging, and that the renal secretion had been restored during the night. Two days afterwards he was able to leave his bed; but his convalescence was IT is now almost three years since I published, in a contem- marked by anasarca, the result of the action of the choleraic porary journal, a number of cases of the very worst form of poison on the vitality of the blood, and of the great diminution English cholera, in which I had obtained a rapid and effectual of its solid constituents by the copious evacuations which cure from the use of the liquor arsenicalis. Since that time I occurred during the urgency of the attack. Now, this case occurred in a dwelling which stood upon a have had ample opportunities of further testing the value of dead flat of ground, from three to four feet below the level of this remedy in cases of English cholera, presenting symptoms the contiguous road, which had consequently no fall for so severe that, had the Asiatic form of the disease been prevaand the cellar of which stood one or two feet deep in drainage, lent at the time, there would probably have been no hesitation water during rainy weather. Its occurrence arose after a in referring the cases in question to that particular type. In heavy fall of rain, and when the imperfect drains in question all these cases the arsenical treatment was followed by such emitted an almost intolerable smell. It is therefore fair to presume that it had its origin in some noxious emanation from rapid subsidence of the symptoms, and by such quick and com- the drains, with which the circumambient air became impregto that restoration I have been led to health, plete regard nated, and thus acquired the power of injuriously impressing arsenic in the light of a specific for cholera. living bodies. It is not in the milder forms of the disease, which are trace. ’7’0 destroy such a poison in the blood, I gare to the blood a able to disturbing injesta, that arsenic will be found beneficial; poison, which acted irr. accordance with a well-known physiobut in those severe and aggravated cases which occur in the logical law, and cured the disease. narrow alleys, badly drained, ill-ventilated dwellings, amidst I have done so in many such cases, in which the ordinary the filth, poverty, and squalid wretchedness of certain districts remedies for cholera had entirely failed, and I have itaaariably of most towns. found that the arsenic exerted a rapid power of control over In the absence of necessary sanitary measures, in the condi- the vomiting and purging, and quickly brought about a state tions favourable to the generation of animal and vegetable of convalescence. poisons, and in the presentation of foci from which the diffusion ’ From such data, then, I maintain the specific action of arsenic of such poisons may take place, Chesterfield is not surpassed, in the very worst form of English cholera, and I thence infer if equalled, by any other inland town of similar size within the for it a similar power in the malignant type of the disease. United Kingdom. It is a fact confirmatory of this remark, In the East, where at the present moment the tenure of our that at no time within the last twelve years has the town been Indian possessions depends on the maintenance of the health entirely free from typhoid fever; that this form of fever and of our soldiers, this dreadful scourge is decimating the heroic epidemic typhus ravage the place at intervals of one or two band under Havelock, and, unless speedily checked, may years; that here scarlatina assumes its malignant form; that possibly lose us an empire which has cost us so much blood and epidemic dysentery is not uncommon; and that during the treasure to win. Let the surgeons of the Indian army adopt. summer and early autumnal months the cases of cholera are this remedy--let them give it a fair and impartial trial-and I numerous, and many of them extremely severe. As an ex- feel confident that with them it will maintain the reputation. ample of the last-mentioned disease, I detail the following case, of a specific for cholera, which I here accord to it. which occurred in my practice in August last, and which, as The instructions for its use are simple and precise. For the one amongst many such, shows alike the character of cholera Asiatic cholera, ten or fifteen drops in cold water, every ten or as it occurs in Chesterfield and its neighbourhood, and the fifteen minutes, until vomiting and purging abate, and then, value of arsenic as a remedial agent :smaller doses, at more distant intervals, until reaction is estaJ. P-,aged forty-two, by trade a master potter, was blished. seized on August 13th of the present year with violent vomiting Chesterfield, September, 1857. and purging, accompanied by frequently-recurring pains in the abdomen, and by general collapse. The dejections were thin, watery, somewhat offensive in odour, and contained a moderate ON A proportion of bile. The vomits consisted of food previously taken, with certain admixture of a thin mucoid fluid. CASE OF ENCEPHALOCELE. These symptoms were combatted by lead and opium, chalk BY ROBERT U. WEST, M.D., Alford, Lincolnshire. mixture with catechu, friction, the application of external heat to the extremities, sinapisms, and turpentine stoups to the MR. LAURENCE prefaces his account of a case of encephalo· abdomen, and by weak cold brandy-and-water to drink. exhibition and the of these remecele, in THE LANCET of Sept. 5th, with speaking of the pnblidiligent application Despite dies, the symptoms increased in severity from hour to hour. cation of a previous case, in which he says he gave a résumé of In the morning of the following day, I received an urgent mes- all the cases recorded up to this his present case. Mr. Laurence sage to attend immediately, as, in the opinion of his friends, the patient would die. On arriving at his home, I found him may add the following case to his résumé. I did not publish in the greatest collapse, with countenance pale, livid, and of a it at the time it occurred. leaden hue; eyes glassy and sunken in their orbits; nose May 29th, 1851.--Mrs. B-, of L-, near Alford, was nipped; tongue pale and besmeared with a thin layer of mucus; delivered, after an easy and perfectly natural labour, of a fullbreath cold; great thirst; skin cold and soddened, with a sized female child, which had a bag of integument of considerclammy perspiration ; voice reduced to a thin, slender, squeak- size hanging down the back from the occiput. This bag conwhich I suspected at once to ing note; pulse thready, running, and incapable of being num- tained fluid and a solid substance, bered. The dejections are involuntary, almost constant, left be brain, in consequence of feeling that a portion of the occiiif;tla nr nn eta.in upon thp bed-linen_ of a faint. sicklv odour. pital bone, in the centre of the expanded or "squamous" 11 por-
itself,
338
and
evidently
frequent,
tion, was wanting. I punctured the bag, and let tity, perhaps two ounces, of bloody serum. The
out
a quan child lived five weeks, and then died, with convulsive symptoms, and a the eyes. For the peculiar, old-looking, staring expression of suffer two or three weeks it appeared to considerably, though for the first fortnight of its life it seemed to thrive, sucking well, and with all the functions well performed. Shortly before its death, the discharge from the puncture became very offensive and purulent. On examination after death, I found the bag contained thE whole of the cerebellum, which was in a purulent and semi putrid state, the result of disease, which was almost a necessar3 consequence of its unprotected state. The skull, which con tained nothing but the cerebrum, was flatter and smaller thai
last
natural. This monstrosity may be regarded as the first stage of th deviation denominated by Geoffroy St. Hilaire, Notencephalie. September, 1857. ________________
A Mirror
attempt
IMPLICATION OF THE HIP-JOINT.
OF THE PRACTICE OF
MEDICINE AND
to save the limb, as the circumstances of the age, constitutional condition, and freedom from intemperance, gave hope of good result. The supinator and long extensor were removed from their tendons, the dislocation reduced, and the forearm placed on a splint; the edges of the wound were gently approximated by strips of wet lint. Little constitutional excitement ensued, and he made rapid progress towards a cure. At the end of a week, there was considerable suppuration, and he was ordered a bread poultice and good diet, including eight ounces of wine. Under the use of nitrate of silver lotion, and oxide of zinc ointment, cicatrization occurred, and he was discharged from the hospital on July l4th. He has at this date (Sept. 22st) a large cicatrice extending the whole length of the forearm; the ulna is tilted upwards from the wrist; and there is scarcely any power of rotation from the forearm, or of extension of the wrist or fingers. Still his power of prehension is gradually increasing, and he is likely to acquire useful power over the hand. It is proposed to assist the extensors by a bracelet, to which is attached a spring to act on the palm of the hand, and so straighten the wrist.
cided to
patient’s
SURGERY
IN THE
HOSPITALS OF LONDON. Nulla est alia pro certo noseendi via, iisi quam plnrimas et morborum e1 dissectionum historms, tam aliorum proprias, eotlectas habere et inter se com. parare.-MORGAGNI. De Sed. et Caus. Morb. lib. 14. Procemium.
LONDON HOSPITAL. MOST EXTENSIVE LACERATION OF THE ENTIRE FOREARM, WITH COMPOUND FRACTURE AND DISLOCATION, THE RESULT OF AN INJURY; SOME OF THE MUSCLES TORN FROM THEIR ORIGINS, AND HANGING FROM THE WOUND; RECOVERY.
(Under the
care
of Mr. CURLING and Mr.
WORDSWORTH.)
IT is really astonishing sometimes to witness the recovery of Since the publication of Mr. Hancock’s very interesting case, patients who have suffered some very severe injury to one of their limbs, so severe and so gravethat very little thought is (THE LANCET, vol. i. 1857, p. 141,) in which that gentleman excised not only the head of the femur, but also the acetabulum requisite, on the part of the surgeon, to determine him to re- itself, we have seen excision of the hip-joint performed several move the member, the condition of which is looked upon as times with a very fair amount of success. And although a the reach conservative efforts to save of it. Under beyond any similar operation upon the knee has been done a far greater such circumstances, we maintain it requires no small amount number of times, yet as that joint has already had some attenof moral conrage to refrain from operative measures; and onr tion bestowed upon it in our Mirror," we purpose devoting a consideration to the hip-joint. principal source of encouragement to do so, is where the age little There can be no question whatever that the most suitable and constitution are otherwise favourable, as they proved to be cases for excision are those in which the head of the bone has in the following example. But a few years ago, this boy’s arm been lying out of its socket for some time, proving a source of would have been amputated as a matter of course, for al- constant irritation and annoyance, by keeping up an exhausting though the details of the case afford a tolerable view of the discharge, associated witch an utter impossibility of moving the as well as sometimes of movement of any kind whatsoinjury, its extent was such as to leave but little hope. had his limb, The position of the unfortunate subjects of exhausting ever. been health otherwise than favourable. Besides other previous disease must be familiar to Such hip-joint surgeon. lesions, some of the principal muscles of the forearm were I cases are the most suitable because theevery acetabulum has had actually torn from their origins, and hanging loose from the time to recover itself, and to become in many instances filled wound, being held by their tendinous attachments. This case up with a new material. Of the recent cases in which excision has been done, none struck us as more favourable for the operawe present as a typical example of what conservative surgery is doing in our hospitals; and it, moreover, well illustrates tion that Mr. Coote’s case, at St. Bartholomew’s, on Sept. 21st, as the head of the bone had been dislocated for some time, the the powers of the upper extremity in recovering from such discharge was not very great, the acetabulum was in a quiescent severe injuries. state, and the structures around the head of the bone were J. W. J-, aged fourteen, admitted April 11th, 1857, tolerably healthy. Sometimes the head of the bone lies imThe same morning, while bedded in pus, which infiltrates the neighbouring tissues, and under the care of Mr. Curling. drawing a truck, he accidentally came into collision with a the patient is much worn out with hectic. With even a greater amount of disease present than what sugar-van, the wheel of which passed over the right forearm, producing a compound fracture of the radius in its upper third, we have represented,-such as disease of the acetabulum more a compound dislocation of the ulna, from the triangular cartior less extensive, attended, perhaps, with actual perforation, lage at the wrist, and a very severe laceration of the integu- pelvicabscess, fistulae about the ischio-rectal fossae, &c.,-this ments and muscles, from the elbow to the wrist. The supi- operation may be done, not only with impunity, but with a nator longus and extensor carpi radialis longior were com- chance of success. They were all present in Mr. Hancock’s pletely severed from their origins, and hanging from the case already cited, in which, moreover, a probe could be passed wound by their tendons; the short radial extensor was partly through a fistulous opening in the groin into the pelvis, and divided; the bone was fractured, without comminution; the from thence out through an opening in the acetabulum. The ulna admitted of easy reduction; the skin, though greatly operation was successful, the whole carious floor of the lastlacerated and contused, was not absolutely destroyed; the named cavity, as well as the diseased head of the femur, being bloodvessels and nerves had escaped injury. In Mr. Curling’s removed. ’’
absence Mr. Wordsworth
was
called to
see
him.
It
was
de-
The recent rlnntrine that these diseased conditions which
339