BRISTOL ROYAL INFIRMARY.

804 had placed the patient in a very precarious condition. Mr. Hill operated by making a curtain flap of anteriorly, and a short posterior flap of the same structure. I The femoral and smaller arteries were secured by torsion, and but little blood was lost in the operation. Mr. Hill afterwards, exhibiting the specimen, showed ’, that the disease primarily commenced in the tibia, and ex- I tended to the upper articular surface. The joint was totally disorganised, and the bones in many parts were eroded. He alluded to a similar case in which he had performed the same operation about fourteen months previously, but. there the progress of the disease was not quite so rapid, and the man was forty-five years of age. He: believes that a specific blood poison, such as pysemia, had given rise to the mischief, and in illustration mentioned an analogous case-that of a woman, under the care of Dr. Brinton in the year 1860, who, after a severe attack of variola, had acute necrosis of the entire femur, implicating both hip- and knee-joints. The specimens of these cases were to be found in the museum.

accompanying hectic,

Provincial Hospital Reports.

integument

BRISTOL ROYAL INFIRMARY. OCCLUSION OF THE FEMORAL ARTERY FOR POPLITEAL

ANEURISM ;

LIGATURE REMOVED IN SEVENTYTWO HOURS.

(Under the care of Mr. AUGUSTIN PRICHARD.)

applied to the femoral artery in the following instance by means of an instrument which is described by the reporter of the case, Mr. W. T. Benham, dresser. Daniel L-,aged nineteen, farm labourer, was admitted on Sept. 20th, 1869, with a well-defined popliteal aneurism on the left side. Forcible flexion, compression of the femoral artery by tourniquets, and forcible extension having been decided. to severally tried, without success, Mr. Prichard occlude the femoral artery by means of an 11 arterial.compressor," which he ordered to be made for the purpose. This little instrument is a hollow metal tube in the form of WEST LONDON HOSPITAL. a cross, three inches in length, and- about the bore of a, No. 8 catheter. The ligature (which may be of almost any OF HYDRATE FAILURE A CASE OF DELIRIUM TREMENS; sort, but in this case was plaited horsehair) is firmly fastened OF CHLORAL TO PROCURE SLEEP. to the cross-piece, the free end being then passed in at (Under the care of Dr. FREDERICK SIMMS.) the mouth of the tube, down through it, and out at the THE following case, from notes supplied to us by Mr. G. other extremity, when the instrument is ready for use. TheHerbert Wade, house-surgeon, would seem to be an instance mode of applying it is as follows: The free end of the ligain which the hydrate of chloral, which has generally been ture is passed round the artery by means of an aneurismneedle, then up through the tube, and out again at its found very useful in delirium tremens, failed to exercise its mouth ; it is then pulled sufficiently tight to occlude the usual soporific influence. artery completely, and is firmly fastened to the cross-piece. John G-, aged thirty-three, married, gate-keeper on Nov. 15th. -1.30 P.M. : The patient having been put railway, admitted April 16th, 1870. The patient had met under chloroform, Mr. Prichard dissected down to the with an accident some time back, which necessitated the femoral artery in the usual manner, and without the removal of the left leg, just below the knee. About a week slightest difficulty applied the compressor in the way indi:or so ago, whilst suffering from the effects of another acci- cated above. The compressor was then placed so as to prodent, he was attacked with symptoms of delirium tremens, ject obliquely at the upper part of the wound, which was and was sent to the hospital. brought together by horsehair sutures. A strip of lint On admission he had a full, frequent pulse, a sulky look, soaked in compound tincture of benzoin was applied over skin hot, eyes presenting a watery appearance, pupils the wound, and the limb was enveloped in cotton-wool and natural. He seemed to have a difficulty in unfastening his bandaged. The patient was removed to bed, and hot-waterclothes. He answered simple questions rationally, but bottles placed on either side of the leg. could not give any account as to his injury. Was ordered 18th.-1.30 P.M.: Patient has passed a good time since half diet, and a pint of beer, and twenty grains of hydrate the operation, with little or no constitutional disturbance. of chloral every six hours. Tongue clean; pulse 80, good; temperature 98° Fahr. On April 16th.—11 P.M.: Has taken two doses of hydrate of examining the wound, it was found to be healed by first chloral. Is excited, and talks very much. Fancies railway intention, excepting at the spot where the compressor protrains are running over him, and that he sees dead children jected. Mr. Prichard then proceeded to remove the instmabout him. Pulse 92.—2 P.M.: Very violent indeed. Diffi- ment, which was easily done by cutting through the two culty in keeping him in bed. Forty grains of hydrate of ends of the ligature which projected from the mouth of the chloral in two ounces of brandy; no result. Twenty grains tube and were fastened to the cross-piece. A little oil was more, in one ounce of brandy, were then given, after which then poured down the tube and it was steadily pulled out of the wound, leaving the two free ends of the ligature he was quiet for half an hour. 17th.—11 A.M.: Has had no sleep. Pulse 124; tongue projecting in its place. One of these was cut off as close to coated. Is so restless and excited that it has been necessary the artery as possible, and, traction being made at the other to have a man to watch him. Is continually picking the end, the ligature was at once removed. No pulsation could bed-clothes. Has taken two eggs for breakfast. To have be felt in the tumour or in the femoral artery below the’ half a pint of beer every three hours.-9 P.M.: Not quite so seat of occlusion ; but, from anastomotic circulation being fairly established, the tibials pulsated slightly. The small restless, but has had no sleep. Takes his food well. 18th.-11 A.M.: Pulse 120. Has been very violent all wound that was left was brought together by a piece of night, and shows no signs of sleep. Ordered half a pint of sticking-plaster, and healed in due course, and the patient beer every three hours, with forty minims of solution of was discharged cured. morphia in it. Bowels not open. Ordered five grains of compound colocynth pill.-9 P.M. : Has had three doses of BRISTOL GENERAL HOSPITAL. morphia with his beer. Pupils are contracted, and he seems A CASE OF PSOAS ABSCESS. inclined to sleep. The hydrate of chloral has been disconthe care of Mr. GEORGE F. ATCHLEY.) tinued since the morning, and he is to continue taking the (Under THE treatment of psoas abscess is in general of a most morphia and beer during the night, if awake. 19th.-11 A.M. : Slept from ten last night till five this nature; for the patient usually lies upon his morning. Is very quiet, and talks rationally. Feels weak. unsatisfactory back for many weeks, perhaps, without much actual pain, Tongue is clean, and not tremulous. Pulse 112. Bowels with have acted twice. Pupils contracted. Is not to take the though great mental anxiety, the effect of long-deferred morphia unless he becomes restless. Ordered full diet, hope. When at length the abscess breaks, there is rarely three pints of beer, and quinine. any expectation of a favourable termination of the case; on 19th.-9 r.M.: He is quite quiet and rational. Pupils the contrary, a more or less speedy death from exhaustion natural. Has eaten well. may be anticipated. The following short notes of a case of this kind indicate a plan-an adaptation of Prof. Lister’s 20th.-11 A.M.: Pulse 100. Going on well. He continued to improve, and was discharged, well, on practice—which may reasonably be expected., Mr. Atchley the 27th. thinks., to furnish a more successful result. A

SHIFTING LIGATURE was

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