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CANCER OF THE TONGUE.
209 have been operated upon by Mr. Solly and Mr. Spencer Wells. In no instance, however, have the fits ceased immediately, consequent upon the operation; so that a relation as between cause and effect could not have existed between phimosis and epilepsy. Yet, Dr. Althaus said, it generally seemed as if the convulsive disorder, after circumcision in such cases, yielded more readily to the remedies employed than it had done before, ____________
FROST ACCIDENTS IN SOME OF THE METROPOLITAN HOSPITALS. A LARGE number of persons met with accidents during the late frost, especially on the memorable night of Tuesday, the 22nd of January, when the streets were covered with frozen
rain. From St. Barthlodomew’s Mr. R. Bond Moore, house-surgeon, gives us the following list of the more severe accidents : Scalp wounds, 5 ; fractures of humerus, 2; dislocations of humerus, 4; fractures of radius and ulna, 3; fractures of radius, 5; fractured ulna, L ; fractures of metacarpal bone of thumb, 2; dislocated thumb, 1 ; compound fracture of tibia and fibula, 1 ; fractured fibula, 1. Of the five who received scalp wounds, two were admitted, one with concussion, and another with rather In two of the fractures of both severe arterial hemorrhage. bones of the forearm there was considerable displacement-in fact, they were all but compound. The above list, with injuries of a more trivial nature, and all traceable to the rain of Tuesday, followed by frost, includes a total number of 117 patients. Besides these, there was an almost endless number of sprains (principally of the wrist and ankle joints), and contusions of various parts. Much praise is due to the dresser on duty, Mr. W. Wingate Saul, who with untiring energy continued to relieve patients through the whole night. During the week ending Jan. 23rd the following accidents from various causes were admitted into Guy’s, under Mr. Poland’s care. Mr. Buck, dresser, has obliged us with, the list. Jan. l6th. —M. H., female, aged fifty-one ; lacerated and contused wounds of right hand. — M. J., female, aged fiftyfour ; fractured tibia and fibula. E. Pt.., male, aged three ; severe burn of chest and abdomen; dead. -J. H., male, aged eight; burn of chest, abdomen, neck, back, and arm.-T. M., male, aged fifteen; concussion of brain. - G. C., male, aged twenty-nine; pistol-shot wound of lower third of left thigh, causing comminuted fracture of femur; amputation. Jan. 17th.-F. B., male, aged thirty; separation of first and second pieces of sternum. J. S., male, aged sixty-three; M. Y., female, aged forty-four; fractured tibia and fibula. femoral hernia. Jan. 18th.—D. C., male, aged twenty; severe laceration of upper third of left thigh and buttock, minor laceration of right thigh; dead. This patient was caught between some cogged wheels. During life, by looking through any of the lacerations of the buttock, one could see completely through the limb to the inner side of the thigh. Dissection showed that the only structures remaining were the shaft of the femur, the femoral artery, sciatic nerve, a few fibres of the rectus -
fibula, extending into ankle-joint; amputation. - E. D., female, aged fifty-six ; fracture of radius and ulna of both arms, contusion of scalp, and laceration of perineum.-A. S., female, aged twenty-two ; fractured fibula. At St. George’s, amongst others, the following very interesting case was admitted. For particulars of it we are indebted to Mr. E. C. Ring, surgical registrar. E. 0-,aged thirty-nine, labourer, was admitted on the 18th, under the care of Mr. Prescott Hewett. He had been engaged in excavating, when a large mass of earth, from being bound together by the frost, suddenly fell en masse without warning, forcing the man against the side of the cutting, and driving the handle of the pick he was working with through his left thigh and pinning him to the earth. The handle was broken off close to the iron, and the man could only extricate himself by drawing his thigh from the wood, which he left in the cutting. On admission, there was a wound in the left thigh, about four inches below Poupart’s ligament, on the inner side of the femoral vessels, its edges being bruised and irregular. On the posterior aspect of the limb was another similar wound, about five inches and a half below the great trochanter, and internal to it. The pulsations of the femoral and tibial arteries were quite normal. There was no haemorrhage, and but little pain. The limb was placed on an inclined plane, and, though some swelling followed, the man has been doing well. The broken handle of the pick is 20l in. in length, 5 in. in circumference at one extremity, and 4g in. at the other. A little redness and swelling near the wounds which existed for a few days subsided. The wound on the upper and inner part of the thigh is nearly well ; but in the one below there is suppuration, and near it a small hard lump, as if some portion of clothing had been left there. On Feb. 3rd he complained of his jaws feeling stiff, but that Mr. Hewett believes to have been due to nervousness, from seeing a man with trismus lying near him; and since his removal to another bed he has recovered. The escape from injury of the femoral artery is very remarkable. Mr. Hewett mentioned to us two cases of analogous character which had come under his care. A man in climbing over the park railings fell, and his thigh was torn up from one end to the other by a spike. In another instance the patient was on horseback, and was caught by the shaft of a Hansom cab, which tore open the groin and upper part of thigh. In neither case was there injury to large vessels. ture of tibia and
’
CLINICAL RECORDS.
-
-
REPEATED RESECTION OF THE KNEE-JOINT. SEVERAL cases have occurred in which delay in healing, and the evident occurrence of necrosis after resection, has rendered a second operation necessary. At King’s College Hospital, under such circumstances, it is thought better to repeat the resection rather than to amputate the thigh. Sir William Fergusson has had three or four such cases, which have done well; and Mr. H. Smith had one in which the proceeding answered perfectly. On Saturday last Mr. Smith again adopted the plan in the case of a lad whose knee-joint he had excised in July last. The boy went on well at first, then fell back, and was sent into the country for a few months-not to much purpose, however, for sinuses about the wound persisted, and showed the presence of dead bone, and the boy’s health was suffering from the prolonged irritation. On opening up the wound, firm anchylosis was found to a limited extent between the femur and Lying behind the former bone was a ragged sequestrum, an inch or two long, representing the intercondyloid space of the femur-that portion of bone which is so often exposed to necrosis. There was an abscess in the head of the tibia. Mr. Smith removed a thin section of this latter bone and a portion of femur, and brought the bones into apposition again just as in ordinary resection. When the sequestrum came to be exan old arterial ligature was found lying about it. This must have been accidentally dropped into the wound in July at the time of operation, and there it had since rested. Was it the presence of this piece of string which excited inflammation leading to the death of the shell of bone described ?
in addition, there lacerations of the penis and scrotum. M. Y., female, aged thirty-nine ; fracture of femur (lower third). D. W., male, aged twenty-nine; contusion of Jan. 19th. H. D., male, aged twelve ; compound fracture of back. finger and lacerations of hand. J. C., male, aged thirteen; acute synovitis of knee-joint after injury. -L. C., female, aged fifteen - contusion of toes. Jan. 20th.—J. H., male, aged three ; fractured tibia. Jan. 21st. J. J., male, aged seventy-six ; strangulated femoral hernia ; operation ; dead.—W. M., male, aged twelve ; contused abdomen. - J. C., male, aged sixty-one ; dislocation of left femur into sciatic notch ; fracture of eighth, ninth, and tenth ribs on left side; fracture of right fibula, and right internal malleolus knocked off. .1 an. 22nd. - M. H., female, aged two ; extensive burns. J. C., male, aged twenty-seven; compound fracture of tibia and fibula.—J. 0., male, aged thirty-four; compound fracture of tibia and fibula ; dead.-H. L., male, aged forty-six; fractured patella.—W. B., male, aged sixty-four; fractured neck of femur.—W. S., male, aged forty-five ; fractured patella.H. K., male, aged fifty-three; comminuted fracture of tibia and 4ibiila. -D. M., male, aged eighteen; contused foot. We Jan. 23rd.—W. M., male, aged nineteen; compound frac- man’s
muscle, and the greater portion of the skin; were severe
-
-
-
-
tibia.
-
-
amined, last,
CANCER OF THE TONGUE. Mr. Paget cut away about one-fourth of an old tongue on Saturday, in the operating theatre of St. Barsaw
210 tholomew’s. The surgeon stood behind the patient, who was of the rectum, and for which the largest number of patients seated in a chair, and, grasping the organ with a vulsellum require operation, is fistula in ano; next in order of frequency held in the left hand, he transiixed it with a knife and rapidly is internal heamorrhoids, and third on the list is fissure of the cut away the diseased portion. A few ounces only of blood- rectum. Out of the 1286 patients admitted at St. Mark’s perhaps four or five-were lost ere the vessels were secured. Hospital in 1866, 138 suffered from fissure : of these, 82 The man had no chloroform. The diseased mass presented a were without complication, 20 were coexistent with internal deep ulcer with hardened base and prominent inverted edges, haemorrhoids, 9 with external haemorrhoids, 3 with polypus, so characteristic of cancer. Mr. Paget remarked that the 3 with stricture, and one, in a boy of five years of age, with écraseur was not needed for removal of a moderate portion of the procidentia. After stating that this affection was often tongue ; there was not more haemorrhage than could be easily overlooked by many surgeons, he insisted on the necessity dealt with in the ordinary way. We have seen of late in this of careful examination [he laid particular stress on digital hospital several cases in which the whole tongue has been re- examination in preference to that by the speculum], not only moved for carcinoma, nothing but a slight composed of for the sake of a correct diagnosis, but also to ascertain the the root being left. Notwithstanding this mutilation, the existence of complications. He observed that the disease was articulation is singularly good, and, paradoxical as it appears, not uncommonly dependent on other morbid conditions of the even lingual sounds are formed so as to be perfectly intellibowel, and referred more especially to polypus, which he illus. gible. In a case of Mr. Paget’s, a man of fifty, who spoke to trated by the case of a lady who had been twice operated on for us on the third day after the operation, we remarked that fissure ; the first operation failed in consequence of a polypoid The patient used growth having remained undiscovered, but the patient recovered even the word " the" was quite distinct. his lips for the utterance of the sound. So it was also in an after the second operation, when this growth was removed. old man whose tongue Mr. Callender had cut out by the After giving a careful description of the symptoms of fissure, écraseur, who could talk and eat with singularly little diffi- the author proceeded to detail the history of several patients upon whom he had operated where complications existed, and culty. remarked that unless the polypi and haemorrhoids were reINCONTINENCE OF URINE SUCCESSFULLY TREATED moved the operation would be afailure. He briefly alluded to the symptoms that should lead the surgeon to suspect the WITH EXTRACT OF BELLADONNA. existence of fissure, laying particular stress on the acute and A healthy-looking country girl, fourteen years old, was long-continued pain after defecation. He was of opinion that brought by her mother. to the Metropolitan Free Hospital on in the early stages of the disease, where it had not existed the llth of January last. She had suffered from nocturnal in- more than six months, it could be successfully treated without continence of urine for the last two years. Not a night passed operation by regulating the bowels and applying locally an without her wetting the bed, and to such an extent that she ointment composed of one scruple of calomel to an ounce of had been compelled to lie upon straw covered with a sheet in lard. That in cases of longer standing, as a rule, operative order to change her bedding daily. She had been taken out interference was necessary. That, in operating, three courses of bed at night, scolded, and ridiculed without any effect in were open to the surgeon-forcible rupture, free incision, and making her abandon the habit. Dr. Drysdale ordered her a limited incision. He discarded the forcible rupture as barquarter of a grain of extract of belladonna as a pill, to be taken barous and offering no advantage, and preferred the free to at bedtime every night. On the 15th of January her mother the limited incision, as in the latter case the wound heals more came to say that she had not wetted her bed since taking the slowly, and in some instances it altogether fails to effect a medicine. Up to the 18th of January there was no return of cure. incontinence of urine. Dr. Drysdale remarked that he had in Mr. ROGERS-HARRISON complimented the author on the many cases seen similar results from the use of belladonna in valuable and practical paper he had read, but said that a plan this disease, and supposed that the drug acted by paralysing of treatment sometimes of much use in such cases had not the detrusor urinæ muscle. been alluded to-he referred to that by pressure,a cone of metal gilt being introduced into the rectum. By this mode slight haemorrhoids, when present, are often cured at the same LOCAL ANÆSTHESIA. time. He preferred, however, the knife to other plans of Mr. Gay showed lately at the Great Northern Hospital an treatment. instrument, which had been made at his suggestion by Messrs. Mr. BAKER Buowjsr, Jun., pointed out the tedious and unsa. Warner and Knight, for producing local anaesthesia by means tisfactory results of medical treatment in such cases, and insisted of methylated spirit of higher specific gravity, and therefore on the necessity of considerable rest on the part of the patient less expensive, and dangerous than that ordinarily used. Its after an operation, for fissure and incisions not thoroughly are apt to reopen. principle is this : The air, from a bellows worked by the foot, Polypi frequently accompany this passes through two tubes. One of these is connected with the affection, and are caused by a portion of the mucous membrane bottle of spirit by means of another to which it is jointed so as being nipped, as it were, in the fissure ; and these polypi, in to produce a spray after the manner of the "scent spray pro- turn, by falling over the fissure, keep up the irritation. He ducers" commonly sold in the shops. Whilst this is distributing advocated a free opening and the subsequent application of a the spirit over the part to be frozen, a current of air issuing piece of oiled lint for twenty-four hours ; it is then only nefrom the other tube produces such rapid evaporation that cessary to see that the fissure is kept clean. Mr. WALTER CoLTLSOrr urged the necessity of a careful freezing is almost instantaneous. Common methylated ether at two shillings per pint is employed. examination in every instance before proceeding to operation. Merely separating the nates, without also making a digital examination, is not sufficient, for in a case within his knowledge, and which made a great impression upon him, a fissure had been operated upon without a prior digital examination having been made, and in consequence it was not until after the operation that coexisting cancer of the rectum was disMEDICAL SOCIETY OF LONDON. covered. He pointed out the occasional dependence of the affection upon haemorrhoids. He did not think that, after the DR. C. J. HARE, PRESIDENT. operation, morethan a few days’ rest was usually requisite. In slight cases great benefit is obtainable from the application before the a Fellows Mr. CAXTON brought man, forty-five of an ointment consisting of forty grains of grey oxide of meryears of age, upon whom he had operated for removal of the cury to one ounce of lard. few weeks a The disease bone superior maxillary previously. Mr. PETER MARSHALL referred to severe neuralgia as now was a myeloid growth about the size of a hen’s egg developed in the antrum. The patient so farhad made a good recovery, and then occurring after the operation for fissure of the rectum, and the resulting deformity was but slight. The only modi- and pointed out, with reference to the polypi sometimes met fication of the usual procedure in this case was, that Mr. with in such cases, that they could not (at least, always) be Canton was unable to save the posterior part of the hard palate produced in the manner which had been suggested, because they quite remote from the fissure. intact. Mr. HENRY SMITH had only met with two cases, of which ALFRED Mr. COOPER read a paper one was in his own practice, in which the operation had failed; ON FISSURE OF THE RECTUM, and in these the symptoms were temporarily relieved. When and commenced with a review of the statistics of St. lTark’s an incision is made it should, without doubt, be a free one, Hospital, which showed that the most common form of disease and a few days’ rest afterwards is usually sufficient. In slight
I
stump
____
healed
Medical Societies
I
are sometimes
FROST ACCIDENTS IN SOME OF THE METROPOLITAN HOSPITALS. A LARGE number of persons met with accidents during the late frost, especially on the memorable night of Tuesday, the 22nd of January, when the streets were covered with frozen
rain. From St. Barthlodomew’s Mr. R. Bond Moore, house-surgeon, gives us the following list of the more severe accidents : Scalp wounds, 5 ; fractures of humerus, 2; dislocations of humerus, 4; fractures of radius and ulna, 3; fractures of radius, 5; fractured ulna, L ; fractures of metacarpal bone of thumb, 2; dislocated thumb, 1 ; compound fracture of tibia and fibula, 1 ; fractured fibula, 1. Of the five who received scalp wounds, two were admitted, one with concussion, and another with rather In two of the fractures of both severe arterial hemorrhage. bones of the forearm there was considerable displacement-in fact, they were all but compound. The above list, with injuries of a more trivial nature, and all traceable to the rain of Tuesday, followed by frost, includes a total number of 117 patients. Besides these, there was an almost endless number of sprains (principally of the wrist and ankle joints), and contusions of various parts. Much praise is due to the dresser on duty, Mr. W. Wingate Saul, who with untiring energy continued to relieve patients through the whole night. During the week ending Jan. 23rd the following accidents from various causes were admitted into Guy’s, under Mr. Poland’s care. Mr. Buck, dresser, has obliged us with, the list. Jan. l6th. —M. H., female, aged fifty-one ; lacerated and contused wounds of right hand. — M. J., female, aged fiftyfour ; fractured tibia and fibula. E. Pt.., male, aged three ; severe burn of chest and abdomen; dead. -J. H., male, aged eight; burn of chest, abdomen, neck, back, and arm.-T. M., male, aged fifteen; concussion of brain. - G. C., male, aged twenty-nine; pistol-shot wound of lower third of left thigh, causing comminuted fracture of femur; amputation. Jan. 17th.-F. B., male, aged thirty; separation of first and second pieces of sternum. J. S., male, aged sixty-three; M. Y., female, aged forty-four; fractured tibia and fibula. femoral hernia. Jan. 18th.—D. C., male, aged twenty; severe laceration of upper third of left thigh and buttock, minor laceration of right thigh; dead. This patient was caught between some cogged wheels. During life, by looking through any of the lacerations of the buttock, one could see completely through the limb to the inner side of the thigh. Dissection showed that the only structures remaining were the shaft of the femur, the femoral artery, sciatic nerve, a few fibres of the rectus -
fibula, extending into ankle-joint; amputation. - E. D., female, aged fifty-six ; fracture of radius and ulna of both arms, contusion of scalp, and laceration of perineum.-A. S., female, aged twenty-two ; fractured fibula. At St. George’s, amongst others, the following very interesting case was admitted. For particulars of it we are indebted to Mr. E. C. Ring, surgical registrar. E. 0-,aged thirty-nine, labourer, was admitted on the 18th, under the care of Mr. Prescott Hewett. He had been engaged in excavating, when a large mass of earth, from being bound together by the frost, suddenly fell en masse without warning, forcing the man against the side of the cutting, and driving the handle of the pick he was working with through his left thigh and pinning him to the earth. The handle was broken off close to the iron, and the man could only extricate himself by drawing his thigh from the wood, which he left in the cutting. On admission, there was a wound in the left thigh, about four inches below Poupart’s ligament, on the inner side of the femoral vessels, its edges being bruised and irregular. On the posterior aspect of the limb was another similar wound, about five inches and a half below the great trochanter, and internal to it. The pulsations of the femoral and tibial arteries were quite normal. There was no haemorrhage, and but little pain. The limb was placed on an inclined plane, and, though some swelling followed, the man has been doing well. The broken handle of the pick is 20l in. in length, 5 in. in circumference at one extremity, and 4g in. at the other. A little redness and swelling near the wounds which existed for a few days subsided. The wound on the upper and inner part of the thigh is nearly well ; but in the one below there is suppuration, and near it a small hard lump, as if some portion of clothing had been left there. On Feb. 3rd he complained of his jaws feeling stiff, but that Mr. Hewett believes to have been due to nervousness, from seeing a man with trismus lying near him; and since his removal to another bed he has recovered. The escape from injury of the femoral artery is very remarkable. Mr. Hewett mentioned to us two cases of analogous character which had come under his care. A man in climbing over the park railings fell, and his thigh was torn up from one end to the other by a spike. In another instance the patient was on horseback, and was caught by the shaft of a Hansom cab, which tore open the groin and upper part of thigh. In neither case was there injury to large vessels. ture of tibia and
’
CLINICAL RECORDS.
-
-
REPEATED RESECTION OF THE KNEE-JOINT. SEVERAL cases have occurred in which delay in healing, and the evident occurrence of necrosis after resection, has rendered a second operation necessary. At King’s College Hospital, under such circumstances, it is thought better to repeat the resection rather than to amputate the thigh. Sir William Fergusson has had three or four such cases, which have done well; and Mr. H. Smith had one in which the proceeding answered perfectly. On Saturday last Mr. Smith again adopted the plan in the case of a lad whose knee-joint he had excised in July last. The boy went on well at first, then fell back, and was sent into the country for a few months-not to much purpose, however, for sinuses about the wound persisted, and showed the presence of dead bone, and the boy’s health was suffering from the prolonged irritation. On opening up the wound, firm anchylosis was found to a limited extent between the femur and Lying behind the former bone was a ragged sequestrum, an inch or two long, representing the intercondyloid space of the femur-that portion of bone which is so often exposed to necrosis. There was an abscess in the head of the tibia. Mr. Smith removed a thin section of this latter bone and a portion of femur, and brought the bones into apposition again just as in ordinary resection. When the sequestrum came to be exan old arterial ligature was found lying about it. This must have been accidentally dropped into the wound in July at the time of operation, and there it had since rested. Was it the presence of this piece of string which excited inflammation leading to the death of the shell of bone described ?
in addition, there lacerations of the penis and scrotum. M. Y., female, aged thirty-nine ; fracture of femur (lower third). D. W., male, aged twenty-nine; contusion of Jan. 19th. H. D., male, aged twelve ; compound fracture of back. finger and lacerations of hand. J. C., male, aged thirteen; acute synovitis of knee-joint after injury. -L. C., female, aged fifteen - contusion of toes. Jan. 20th.—J. H., male, aged three ; fractured tibia. Jan. 21st. J. J., male, aged seventy-six ; strangulated femoral hernia ; operation ; dead.—W. M., male, aged twelve ; contused abdomen. - J. C., male, aged sixty-one ; dislocation of left femur into sciatic notch ; fracture of eighth, ninth, and tenth ribs on left side; fracture of right fibula, and right internal malleolus knocked off. .1 an. 22nd. - M. H., female, aged two ; extensive burns. J. C., male, aged twenty-seven; compound fracture of tibia and fibula.—J. 0., male, aged thirty-four; compound fracture of tibia and fibula ; dead.-H. L., male, aged forty-six; fractured patella.—W. B., male, aged sixty-four; fractured neck of femur.—W. S., male, aged forty-five ; fractured patella.H. K., male, aged fifty-three; comminuted fracture of tibia and 4ibiila. -D. M., male, aged eighteen; contused foot. We Jan. 23rd.—W. M., male, aged nineteen; compound frac- man’s
muscle, and the greater portion of the skin; were severe
-
-
-
-
tibia.
-
-
amined, last,
CANCER OF THE TONGUE. Mr. Paget cut away about one-fourth of an old tongue on Saturday, in the operating theatre of St. Barsaw
210 tholomew’s. The surgeon stood behind the patient, who was of the rectum, and for which the largest number of patients seated in a chair, and, grasping the organ with a vulsellum require operation, is fistula in ano; next in order of frequency held in the left hand, he transiixed it with a knife and rapidly is internal heamorrhoids, and third on the list is fissure of the cut away the diseased portion. A few ounces only of blood- rectum. Out of the 1286 patients admitted at St. Mark’s perhaps four or five-were lost ere the vessels were secured. Hospital in 1866, 138 suffered from fissure : of these, 82 The man had no chloroform. The diseased mass presented a were without complication, 20 were coexistent with internal deep ulcer with hardened base and prominent inverted edges, haemorrhoids, 9 with external haemorrhoids, 3 with polypus, so characteristic of cancer. Mr. Paget remarked that the 3 with stricture, and one, in a boy of five years of age, with écraseur was not needed for removal of a moderate portion of the procidentia. After stating that this affection was often tongue ; there was not more haemorrhage than could be easily overlooked by many surgeons, he insisted on the necessity dealt with in the ordinary way. We have seen of late in this of careful examination [he laid particular stress on digital hospital several cases in which the whole tongue has been re- examination in preference to that by the speculum], not only moved for carcinoma, nothing but a slight composed of for the sake of a correct diagnosis, but also to ascertain the the root being left. Notwithstanding this mutilation, the existence of complications. He observed that the disease was articulation is singularly good, and, paradoxical as it appears, not uncommonly dependent on other morbid conditions of the even lingual sounds are formed so as to be perfectly intellibowel, and referred more especially to polypus, which he illus. gible. In a case of Mr. Paget’s, a man of fifty, who spoke to trated by the case of a lady who had been twice operated on for us on the third day after the operation, we remarked that fissure ; the first operation failed in consequence of a polypoid The patient used growth having remained undiscovered, but the patient recovered even the word " the" was quite distinct. his lips for the utterance of the sound. So it was also in an after the second operation, when this growth was removed. old man whose tongue Mr. Callender had cut out by the After giving a careful description of the symptoms of fissure, écraseur, who could talk and eat with singularly little diffi- the author proceeded to detail the history of several patients upon whom he had operated where complications existed, and culty. remarked that unless the polypi and haemorrhoids were reINCONTINENCE OF URINE SUCCESSFULLY TREATED moved the operation would be afailure. He briefly alluded to the symptoms that should lead the surgeon to suspect the WITH EXTRACT OF BELLADONNA. existence of fissure, laying particular stress on the acute and A healthy-looking country girl, fourteen years old, was long-continued pain after defecation. He was of opinion that brought by her mother. to the Metropolitan Free Hospital on in the early stages of the disease, where it had not existed the llth of January last. She had suffered from nocturnal in- more than six months, it could be successfully treated without continence of urine for the last two years. Not a night passed operation by regulating the bowels and applying locally an without her wetting the bed, and to such an extent that she ointment composed of one scruple of calomel to an ounce of had been compelled to lie upon straw covered with a sheet in lard. That in cases of longer standing, as a rule, operative order to change her bedding daily. She had been taken out interference was necessary. That, in operating, three courses of bed at night, scolded, and ridiculed without any effect in were open to the surgeon-forcible rupture, free incision, and making her abandon the habit. Dr. Drysdale ordered her a limited incision. He discarded the forcible rupture as barquarter of a grain of extract of belladonna as a pill, to be taken barous and offering no advantage, and preferred the free to at bedtime every night. On the 15th of January her mother the limited incision, as in the latter case the wound heals more came to say that she had not wetted her bed since taking the slowly, and in some instances it altogether fails to effect a medicine. Up to the 18th of January there was no return of cure. incontinence of urine. Dr. Drysdale remarked that he had in Mr. ROGERS-HARRISON complimented the author on the many cases seen similar results from the use of belladonna in valuable and practical paper he had read, but said that a plan this disease, and supposed that the drug acted by paralysing of treatment sometimes of much use in such cases had not the detrusor urinæ muscle. been alluded to-he referred to that by pressure,a cone of metal gilt being introduced into the rectum. By this mode slight haemorrhoids, when present, are often cured at the same LOCAL ANÆSTHESIA. time. He preferred, however, the knife to other plans of Mr. Gay showed lately at the Great Northern Hospital an treatment. instrument, which had been made at his suggestion by Messrs. Mr. BAKER Buowjsr, Jun., pointed out the tedious and unsa. Warner and Knight, for producing local anaesthesia by means tisfactory results of medical treatment in such cases, and insisted of methylated spirit of higher specific gravity, and therefore on the necessity of considerable rest on the part of the patient less expensive, and dangerous than that ordinarily used. Its after an operation, for fissure and incisions not thoroughly are apt to reopen. principle is this : The air, from a bellows worked by the foot, Polypi frequently accompany this passes through two tubes. One of these is connected with the affection, and are caused by a portion of the mucous membrane bottle of spirit by means of another to which it is jointed so as being nipped, as it were, in the fissure ; and these polypi, in to produce a spray after the manner of the "scent spray pro- turn, by falling over the fissure, keep up the irritation. He ducers" commonly sold in the shops. Whilst this is distributing advocated a free opening and the subsequent application of a the spirit over the part to be frozen, a current of air issuing piece of oiled lint for twenty-four hours ; it is then only nefrom the other tube produces such rapid evaporation that cessary to see that the fissure is kept clean. Mr. WALTER CoLTLSOrr urged the necessity of a careful freezing is almost instantaneous. Common methylated ether at two shillings per pint is employed. examination in every instance before proceeding to operation. Merely separating the nates, without also making a digital examination, is not sufficient, for in a case within his knowledge, and which made a great impression upon him, a fissure had been operated upon without a prior digital examination having been made, and in consequence it was not until after the operation that coexisting cancer of the rectum was disMEDICAL SOCIETY OF LONDON. covered. He pointed out the occasional dependence of the affection upon haemorrhoids. He did not think that, after the DR. C. J. HARE, PRESIDENT. operation, morethan a few days’ rest was usually requisite. In slight cases great benefit is obtainable from the application before the a Fellows Mr. CAXTON brought man, forty-five of an ointment consisting of forty grains of grey oxide of meryears of age, upon whom he had operated for removal of the cury to one ounce of lard. few weeks a The disease bone superior maxillary previously. Mr. PETER MARSHALL referred to severe neuralgia as now was a myeloid growth about the size of a hen’s egg developed in the antrum. The patient so farhad made a good recovery, and then occurring after the operation for fissure of the rectum, and the resulting deformity was but slight. The only modi- and pointed out, with reference to the polypi sometimes met fication of the usual procedure in this case was, that Mr. with in such cases, that they could not (at least, always) be Canton was unable to save the posterior part of the hard palate produced in the manner which had been suggested, because they quite remote from the fissure. intact. Mr. HENRY SMITH had only met with two cases, of which ALFRED Mr. COOPER read a paper one was in his own practice, in which the operation had failed; ON FISSURE OF THE RECTUM, and in these the symptoms were temporarily relieved. When and commenced with a review of the statistics of St. lTark’s an incision is made it should, without doubt, be a free one, Hospital, which showed that the most common form of disease and a few days’ rest afterwards is usually sufficient. In slight
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