CHARING-CROSS HOSPITAL.

628 The first and second attempts to introduce a fine catheter failed; but after he had a week’s rest and treatment in the hospital, Mr. Coulson was able to introduce a No. 1 catheter into the bladder, and subsequently progressively higher numbers were introduced until a full sized one passed easily.

ST. GEORGE’S HOSPITAL. PROSTATIC

TUMOUR

PROJECTING

DISEASE OF THE

(Under the

ULCER ABOVE THE HEEL PREVENTED FROM CICATRIZING BY A

BLADDER; care

INTO THE

BLADDER ;

FATAL RESULT.

of Mr. JOHNSON.)

JoHN D-, aged fifty-one, was admitted on Dec. 12th, EQUINUS; CURE AFTER TENOTOMY. 186U, with symptoms of inflammation of the bladder, and a (Under the care of Mr. URE.) tumour of the prostate, of which he died on Jan. 9th, 1861. Tension of the integument in the following case was pre- The examination of the body was prevented by the friends; but venting cicatrization in the ulcer above the heel, and in as it was desirable to ascertain the presence of a foreign body order to render the skin more lax and easily drawn together, in the bladder, an incision was made into that viscus from the as Prof. Syme inculcates in his work on Surgery, the tendoAchillis was divided, which not only cured the ulcer, but also perineum, and the finger introduced. A very movable pedunculated tumour projected into the bladder from the prostate the club-foot :and floated about most freely in front of the finger. gland, F. T-,aged ten, of fair complexion and grey irides, was admitted December 1st, 1860, with a chronic ulcer of the right Fragments of it were removed, and presented the usual appearances of prostatic tumours. The bladder was of large size; so leg, about three inches above the heel, of two months’ stand- that it was the only forefinger into its whole length by sinking ing. It was of a triangular form, about two inches in length, that its farther wall could be touched. It felt columnar, and and an inch and a half at the base, and showed no inclination in some places the mucous membrane seemed to have been to heal. It was produced by his having slipped from a waggon about four months previously. There was also talipes equinus, pressed in between the muscular columns, forming small the result of the same accident. As Mr. Ure considered the pouches. tension of integument connected with the club-foot was preventing cicatrization of the sore, he divided the tendo-Achillis CLINICAL RECORDS. on Dec. 19th, subcutaneously at the level of the outer ankle. Poultices were applied, and afterwards a lotion of chloride of EXOSTOSIS ON THE TEMPORAL BONE. soda, and by the 23rd January, 1861, it was ascertained that the sore was all but healed; but there was still talipes equinus RosiNA S-, aged twenty-three, was admitted into the to some extent, and accordingly Mr. Ure directed Scarpa’s Bloomsbury Dispensary on December 20th, 1860, under the shoe to be used. care of Mr. Cooper, with a hard and immovable tumour behind Feb. 4th.-Heel is now quite down in the Scarpa’s shoe. the right ear, and just above the mastoid process. Its base 7th.-Can step with his heel to the ground. Cured. was broad ; in shape and size it resembled a large walnut. At times it occasioned great pain, and, if handled, was extremely sensitive. She states that it appeared about four years ago CHARING-CROSS HOSPITAL. without any assignable cause, and has grown to its present dimensions within that period. She is highly nervous, and of TETANOID SYMPTOMS IN A CASE OF CHRONIC AURAL hysterical temperament; but being very desirous of having it DISEASE. removed, in consequence of its interference with her bonnet(Under the care of Dr. WILLSHIRE.) strings, being a dressmaker, on January 3rd Mr. Cooper perIF the tetanoid symptoms which suddenly supervened in the formed the operation by everting the flaps and freely exposing the tumour, which proved to be a solid ivory exostosis. It refollowing case were the consequence of an exacerbation of quired the bone-pliers to be used with considerable force before the aural symptoms, chronic since childhood, then it must any impression could be made on its substance, the scalpel be regarded as an almost unique example of complicated being quite useless in this proceeding. The after treatment aural disease; for on looking over the records of aural surgery, consisted of linseed poultices, Dover’s powder at bedtime, with attention to the bowels. In a month she was discharged cured. we cannot find that opisthotonos has followed otitis with profuse discharge from the ears. Most probably the co-existence of the tetanoid and aural diseases was a mere coincidence. GANGRÆNA SENILIS, OR DRY GANGRENE. The case, however, possesses some interest from the readiness with which the opisthotonos subsided on the exhibition of purANTE G-, aged sixty-five, married, who has been in service from the days of her childhood, and for many years as housegative remedies. For the following short notes we are indebted to Mr. Chas. keeper in wealthy families, was admitted into the Bloomsbury J. Myers, clinical clerk :Dispensary on November 15th, 1860, with the symptoms of John P-,aged twenty-four years, was admitted on the gangrene of the right foot. It presented a dingy, night of the 28th of April, with tetanic symptoms. It appears congestive redness over the instep and base of all the toes, with that when a child he had an attack of scarlatina, and during bullæ on the surface. The pain was of a burning character, its progress tenderness of and discharge from both ears occurred. and most excruciating; the toes of rather dark or leaden hue, The subsidence of the fever brought no relief from the aural but especially the big toe and its adjoining one, which were. trouble, which has continued in a chronic form until the pre- darker in colour; the temperature ef the foot was below its sent period, the general result being that he has been brought ordinary heat; the pulsation of the posterior tibial artery very up almost like a deaf mute. He complains now of pain, great indistinct, and that of the femoral by no means normal. The tenderness, and copious purulent discharge from both ears, countenance was expressive of much anguish, and the pulse at accompanied by almost entire loss of hearing. A few hours the wrist feeble, but not intermittent. Warm fomentations before admission he ran wildly into the room, attempted to three times a day were ordered to be used, and the limb to be strangle his mother, and betrayed other symptoms of nervous wrapped up in wool. To have a mixture of carbonate of derangement, which at length passed into tetanus. While in ammonia, tincture of opium, and infusion of cascarilla every the hospital, opisthotonos continued for four hours with but four hours; at night a drachm of tincture of opium in brandylittle intermission. A drop of croton oil and an emetic were and-water ; diet to be liberal, with brandy. given; a blister also was placed upon the nape of the neck. Up to December 19th she progressed favourably, when the April 29th.-The spasms have abated; but he complains of heel and sole of the foot assumed a dark hue, with great pain. general uneasiness of the spine, especially of its cervical por- To use an embrocation of soap liniment, ammonia, and laution. The ears still discharge matter, and are painful. To danum night and morning; the wool and other remedies to be take a pill directly, composed of a drop of croton oil, and five continued. 26th.-She is threatened with soreness of the nates from bed grains of the extract of colocynth. 30th.-The spine continues painful; but he has not had any pressure, for which a spirit lotion was used. return of the tetanus. The tongue is whitish, and the bowels Jan. 4th.-Is much improved in health and strength, but the relaxed. To have an ounce of the nitrate of potass mixture big toe and its adjoining one are quite black, with a line of three times a day. The head is to be shaved. demarcation formed at their base. Ordered a linseed poultice May 14th.-The patient has gradually improved up to the thrice a day, and all other remedies to be continued. Feb. 4th.-The big toe has come away, and its neighbour present time, and has been able to walk out the whole of the last week. The ears are less painful; but he is as deaf as followed it four days afterwards. i before. He left the hospital to-day. 28th.-The wounds have healed; cured. TALIPES

approaching