CHARING-CROSS HOSPITAL.

119 formerly might have been: he did not remove myrrh lotion was used, and union had satisfactorily taken place. One of the stitches, as sometimes happens, had fallen out spontaneously. As to the hard palate, the gap had already become smaller by the contraction of the velum below it. Mr. Fergusson purposes, after a little while, to endeavour to close the greater portion of the hard palate, bybringing the mucous membrane together, and, with a mechanical contrivance, speech will probably be much improved. As to mechanical contrivances, we would just cursorily remark that we saw, last summer, a very neat obturator, brought to London, by M. Liier, of Paris. It consists merely of two strong cylindrical caoutchouc rings loosely superposed, one being double the siza of the other; the larger one is introstance

the

as

he

stitches,

a

source of irritation, probably necrosed removed. When the patient was under the influence of chloroform, (which agent caused at first so much excitement as to require the assistance of six persons,) Mr. Fergusson made an incision from three to four inches in length, unconnected with either of the fistulous apertures, being, in fact, a kind of counter opening. This incision over the supposed site of the necrosed bone was preferred to largely laying open the sinuses, as thus the wound was less extensive. By introducing the finger, a piece of dead bone was now felt, the pointed gouge was introduced, the bone raised, and by the forceps a piece of necrosed bone, about the size of a small orange, was extracted. Mr. Fergusson remarked that a good deal of uncertainty had existed in this case, and that the present result showed how useful and proper it is thoroughly to investigate the state of the parts, and assist nature in the process of extrusion. He considered that twenty years might have been necessary for unassisted nature to accomplish what he had done in about as many minutes. Recoveries, in cases like the present, were very rapid, and the patient had now every favourable chance on his side.

be

expected unless the

bone,

was

duced into the fissure which the lesser one immediately the neck between the two rings being caught in the fissure. None but actual force and lateral pulling can displace this obturator. We lately noticed a case at the Royal Free Hospital, under the charge of Mr. Gay, which not only presented a fissure of the velum, but a complete separation of the hard palate even to the incisors, with double harelip. The operations were here performed upon those various defects separately, and the final result, especially as to the CHARING-CROSS HOSPITAL. approximation of the bony parts, has been very satisfactory. The girl will probably, with the aid of an obturator, regain a Cases of Acute Rheumatism; Treatment by Lemon-juice; natural voice, and her appearance is of course vastly imRapid Cure. proved. The details of this case, where Mr. Fergusson’s the charge of Mr. HANCOCK.) (Under method was fully carried out, will soon be brought before our MR. HANCOCK has lately been trying the lemon-juice in readers, and no doubt prove extremely interesting. acute rheumatism, with two patients, according to Dr. Owen CASE 3.-In this instance, the subject is a woman, about Rees’s plan, and both recovered in about a week. The first twenty-five years of age, of a very nervous and excitable tem- patient is a servant girl, of twenty-three years, who was adperament. The deficiency in the velum is not congenital, but mitted, Dec. 30, 1851, with acute rheumatic pain in the right has resulted from a sloughing process which took place in the wrist, which flew, two days afterwards, to the left, the joints part. The perforation which had ensued was large enough to in both cases being red and swollen. The shoulders were admit the tip of the index finger, and this state of things had subsequently involved, and the perspiration was profuse. The the usual effect on the articulation of words. patient took, at first, calomel and Dover’s powder, and cooling The first steps of the operation, which took place on the alkaline draughts. On the second day, she was ordered one 17th of January, 1852, were the same as in the above Cases- ounce of lemon-juice every fourth hour, and went on taking viz. the division of the lavatores palati, and the anterior fibres these doses, with an occasional anodyne at night, for ten days, of the palato-pharyngeus muscles. But besides these measures, when all the above-mentioned symptoms had disappeared. Mr. Fergusson thought it likewise necessary to detach the Mr. Hancock now prescribed quinine and quassia, the patient upper partof the velum from the bone, herein following only complaining of weakness and want of appetite. the advice given by Dr. Warren, of the United States of The second case refers to a man of forty years, who was America. By these incisions the velum lost much of its ten- admitted, Jan. 6,1852, with a non-rheumatic affection of the sion, and the aperture in it looked smaller. The fits of cough- knee. Whilst under treatment, lie was suddenly attacked ing and spasmodic contortions of the patient were very dis- with pain, swelling, and redness of the left wrist. Mr. tressing, and put the patience of the operator to a severe test; Hancock ordered half an ounce of lemon-juice, three times a but the stitches were applied in the manner described above, day. This dose was taken for a week, when we were kindly the parts not offering much resistance, as they were com- shown the patient, who had regained the full use of the wrist. There were no heart complications in either case. pletely relaxed. Mr. Fergusson stated that he entertained some doubts as to union in this exceptional case; but he still preferred the proceeding to which he had resorted to certain measures of MIDDLESEX HOSPITAL. plastic surgery which had been recommended. Mr. FergusCase qf A neurism of the A rte1’ia I nntYffitinata. son had had no ocular demonstration of their good effects, he the charge of Mr. SHAw.)) had only seen prints and books regarding this kind of operations, and on these he could not put implicit reliance. After THERE is now in Percy ward, a man, sixty years of age, and this patient had retired, Mr. Fergusson removed a piece of a bricklayer by trade, who is suffering from aneurism of the necrosed bone from a young man; under circumstances of pe. arteria innominata. The disease has been noticed by the culiar interest. patient for the last two years, and has now reached the size of a turkey’s egg. It lies behind the two sterno-clavicular Necrosis of Portion of t7te Ilium. articulations, beats very strongly, and sinks somewhat into (Under the care of Mr. FERGUSSON.) the chest behind the upper bone of the sternum. The man James R-, aged twenty-six, noticed, about two years has always enjoyed good health, but is now affected with a previous to his admission into Canterbury ward, a swelling just severe cough, which is probably owing to pressure on the below the vertebral column, in the right iliac region. It gra- trachea, or on the recurrent nerve. Surgery cannot do much dually increased in size, but did not cause much pain, nor in such a case, as the only plans that could be adopted are prevent him from attending to his work. About six months more hazardous than the disease-viz. the tying of the innoprevious to his applying here, two abscesses, in the lumbar minata between the heart of the tumour; tying both the suband sacral regions, were opened at St. George’s Hospital, and clavian and carotid on the distal side of the tumour, (Brasdor;) he left that institution much relieved. On examination he was or coagulating the blood in the sac by an electro-galvanic current, now found to present a large, diffuse, reddish swelling above (Petrequin of Lyons.) Soothing measures are meanwhile emand behind the right hip, where two openings, respectively ployed, both externally and internally. leading iuto sinuses, were also noticed. One of these was situated over the sacrum; the other over the posterior portion of the ilium. The probe introduced along these fistulous GUY’S HOSPITAL. tracts, did not detect dead bone very distinctly, but strong Removal of a .N aeVU8 by the Platinuoi Wire, heated by a Galvanic suspicions were entertained that such was existing at the back Current. of the ilium or upper part of the sacrum. Mr. Fergusson the of Mr. HILTON.) (Under charge directed soothing applications to the part, and tonics interOun readers probably remember the cases of fistula in ano nally, and on the 17th of January, 1852, the young man was brought into the theatre, as it was clear that no benefit could and hsemorrhoids successfully treated by Mr. Marshall, at

closes,

(Under