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HÆMORRHAGE FROM THE REMOVAL OF DEAD BONE.
merchant service, in which he continued for five years; since then he has been engaged at hotels. For the last five years he has been occupied as potman and waiter, and has generally every morning scoured between five and six dozen of pewter pots. About twelve or fourteen yearsago he had a sore on the penis, for which he used some black wash ; he does not appear to have taken any mercury, or to have had any secondary symptoms. On the 22nd June, he felt a violent pain in the abdomen, with cramps in his legs ; he was very sick, and had no appetite. The following day (23rd) he applied at the hospital as an out-patient. Some castor oil was prescribed for him, half to be taken directly, and the remainder on the ensuing morning. He rejected the first dose, and the same evening took half an ounce of salts ; about four o’clock the following morning he took another half ounce, both of which doses he vomited. About twelve o’clock he took the other dose of oil, which he likewise rejected. He then applied to a surgeon, who gave him a dose, which he threw up as soon as he reached home. On June 25th, he applied for admission at this hospital. The house-physician saw him, and ordered warm fomentations to the abdomen. He still continued sick, with pain and spasm, and on the same evening he was admitted. His tongue was coated in the centre with a brown fur; pulse 70 ; has great pain in the abdomen, which is much relieved by pressure and warmth. Bowels had been constipated since the 23rd. There is a decided blue line on the gums at the margins of the teeth ;-, the breath is rather feetid ; urine healthy, acid, no albumen present. Ordered five grains of compound soap pill every four hours, and an enema of warm water. 28th.-Yesterday morning he had castor oil, and the enema He does not now feel much griping pain in the was repeated. abdomen. The bowels were twice relieved on the evening of his admission, and once on the day following (26th). To have two colocynth pills; and three grains of iodide of potassium and one of sulphate of iron thrice a day in water. 30th.-Bowels have not been relieved since the 27th. He has occasionally ardor urinse; no cramps in his limbs; pain in the abdomen comes on now and then, but has abated much in
severity. Appetite good. July 2nd.-Bowels have
not been relieved since the 30th.
but the forefingers and thumbs cannot be used. She of course gave up her old occupation when she first came under treat. ment. Her general health has always been good. A short time back we saw a case under Mr. Erichsen’s care, at University College Hospital, of a man who had temporary paralysis of the supinators of his right forearm, from the constant use of tailors’ shears.
GOITRE SUCCESSFULLY TREATED BY LARGE DOSES OF BROMIDE OF POTASSIUM AND LIQUOR POTASSÆ. CASES of goitre, and especially those of long standing, are some of the most troublesome and unsatisfactory that fall
under the notice of practitioners. In many of them, even where treatment has been successful for a time, it sometimes happens that from very trifling exciting causes the gland enlarges to as great a size as ever. During the past year we had the oppor. tunity of seeing over a dozen examples of goitre, under Dr. O’Con. nor’s care at the Royal Free Hospital. In a few of those cases, iodide of potassium, in small doses, gradually increased to much larger ones, with the external application of strong iodine paint, was tried without benefit. The same remedies in combination with steel, and generous living, were equally unsuccessful. Bromide of potassium, in doses of five grains, with ten minims of liquor potassae in infusion of quassia, was next tried, and continued for some time, with benefit, the bromide being gradually increased to doses-of twenty.five grains, three times a day, with forty minims of liquor potassse. In all the instances in which it was given for a proper length of time, the result was a complete disappearance of the glandular enlargement. The minimum dose of the bromide now administered in these cases by Dr. O’Connor is ten grains, with twenty minims of liquor potassse and infusion of quassia. There are now three patients under treatment in whom the progressively beneficial effects of this remedy are clearly discernible. In many of these cases strong iodine paint is used We have heard Dr. O’Connor state, that as an application. the bromide of potassium does not produce any of the depress. ing effects of the iodide, which is a practical point of very great
He does not feel much pain; appetite good; urine still scalds very much; sleeps well. To have half a drachm of acetate of
potass in an infusion of quassia thrice a day. 5th.-Has a little pain occasionally in the left groin; tongue clean; the pain on micturition continues; urine rather deficient
ih’quantity.
7th.-He has passed more urine, and. does not suffer from any pain whatever, but feels weak. Appetite good. 9th.-Left the hospital yesterday. Blue line on the gums much diminished.
CLINICAL
RECORDS.
importance. BRONCHOCELE COMMON TO MANY OF THE ENGLISH COUNTIES. THE name of Derbyshire neck used to be given to goitre, or enlargement of the thyroid glands, from the remarkable prevalence of the affection at one time in the county of Derby. This malady is, however, met with sporadically in other counties. Thus some of the cases which we have seen at the Royal Free Hospital were from Kent, Surrey, Bedford, &c.; and we lately saw one, under Dr. Willshire’s care, at the Charingcross Hospital, from Hampshire, the patient being a woman of about twenty-two years of age, who was born and brought up in that county. She had a very large bronchocele extending to both sides of the neck, and was given three or four gains of iodide of potassium, with twenty minims of the tincture of iodine during the day, iodine being used externally as well. It is probable she might have improved had her health not otherwise given way. She was a stout woman, with a ruddy complexion, accustomed to much exercise, and the mere change from country to town air evidently disagreed with her, for she became pale, and the catamenia ceased, whilst under treatment. She, therefore, left the hospital, and returned to her native county. It would appear that the great majority of cases of bronchocele met with in London come from the metropolitan counties.
PALSY AND WASTING OF THE FLEXORS OF THE FOREARM. FROM HAT-PRESSING. IN wrist-drop, or palsy of the forearm and hand, in who are subject to the poisonous influence of lead, the extensor muscles are chiefly affected, and wrist-drop is the result. The fingers are seen to be flexed upon the hand, and the hand upon the forearm. The affection is a peculiar one, and not easily mistaken. We had the opportunity of seeing an opposite condition to the above at Guy’s Hospital, on the 6th December, in the person of a young woman, aged twenty-two years, whose occupation was that of a hat-presser. In her there was paralysis of the flexors of the forearm and hand, with wasting of the HÆMORRHAGE FROM THE REMOVAL OF . muscles. For five years, whilst employed in her avocation, DEAD BONE. this affection had been gradually coming on, and at last she IN the union of a severely comminuted and compound frac. had to give it up, as her hands and forearms were almost useless. When she first came under the care of Mr. Bryant, about ture, the normal position of parts will sometimes become the course of even one of the larger bloodvessels twelve months ago, the bones of the metacarpus could be plainly seen and felt in the palm, and the entire anterior aspect of the This is only to be discovered when any may be altered. forearm was shrunken and wasted. She could not flex the operation is subsequently required, such as the removal ofa hands upon the wrists, and could scarcely hold anything. piece of bone. An illustration in point was presented to Under the use of galvanism three times a week for nearly a our notice at St. George’s Hospital on the 22nd of December. was brought into the operating theatre with year, she can now, however, flex the wrist pretty freely, and An bone over the site of a fracture of the left tibia, which can grasp any substance with the fingers only, but the latter do not freely bend into the palm of the hand. The fleshy por- occurred two years ago. The bone was broken into several tion of the flexors of the forearm has, to some extent, regained pieces, and a wound communicated with the fracture. The its normal size, but the tendency of the hands and wrists is leg was carefully put up, and union ensued, with some slight to bend backwards. The backs of both hands appear natural, deformity, but ’nevertheless a good limb was saved. SOIl1e
persons
changed, and dead necrosed elderly man
62
dead bone remained, and was the cause of much trouble. Mr. Cassar Hawkins used the trephine, and removed the whole of it. It was necessary to employ the scalpel in reflecting back the tissues, and in doing this the anterior tibial artery was wounded; its course had somewhat deviated across the frac- ROYAL MEDICAL & CHIRURGICAL SOCIETY. ture, and it seemed to be lodged in a fossa formed by a proTUESDAY, JAN. 10TH, 1860. jecting piece of bone. Attempts were made to take up the vessel with the forceps, and to apply a ligature, but all were MR. F. C. SKEY, F.R.S., PRESIDENT. unsuccessful, until a square mass was dissected away and isolated, including the vessel, when a ligature, placed over all, OF TROPICAL CLIMATES ON THE RISE AND stopped further bleeding. The haemorrhage, however, was ON THE INFLUENCE PROGRESS OF INFLAMMATORY AFFECTIONS OF THE WOMB. most difficult to control until this process of isolation was adopted by Mr. Pollock. The patient is going on well, and BY E. J. TILT, M.D., M.R.C.P., free suppuration has been established. THE GENERAL
Medical Societies.
SENIOR PHYSICIAN TO
FARRINGDON
DISPENSARY
AND LYING-IN CHARITY.
HERNIA.
TUMID ABDOMEN WITH AN UMBILICAL OF all the varieties of hernia of the abdominal cavity, it is
THE scantiness of our information upon this point was first noticed by Dr. Tilt, whose attention had been drawn to it by having had to attend, during the last ten years, patients invalided by uterine inflammation, in the East or West Indies, in China, and Brazil. Proceeding to investigate the etiology of uterine disease amongst Europeans in tropical climates, Dr. Tilt took India as an example, and pointed out how, even if the menstrual function had been previously regular in young women going out to India, it became irregular from travelling and the sea voyage; how, without passing through a period of repose, on arriving in India, and before the menstrual function had had time to " right itself," these emigrants were launched into the fatigues and gaities of society, often marrying at too early an age, and even before menstruation had become regular. Dr. Tilt observed that, little accustomed to the heat of India, the inexperienced European often imprudently exposed herself, during the menstrual period, to the raw, chilly night air, or to the north-wester, or made too frequent a use of cold water at that time. The pathology of tropical climates was
somewhat rare to find the umbilical form come on late in life, unless the patient has been subject to it shortly after birth. Women who have had the abdomen frequently and greatly distended by giving birth to numerous children have become ruptured a little to one side of the umbilicus. There was very lately a female patient, forty-six years of age, in St. Bartholomew’s Hospital, under Dr. Farre’s care, the subject of an irreducible umbilical hernia for the last ten years. She is not the mother of a large family, but at the period mentioned she was greatly fatigued from nursing a little I boy ; this not unfrequently caused much straining, which I gave rise to the tumour. She was seen, at Dr. Farre’s request, by Mr. Lloyd, who found that nothing could be done in the way of reduction. This patient was admitted on Dec. 15th, with tumidity of the abdomen and constipation. With the exception of these symptoms, her health is pretty good, and she has long worn an abdominal belt. She is not, however, easy unless the bowels are moved some five or six times a day ; represented as being principally abdominal, Europeans becomoccasionally subject to liver disease and dysentery, which they are seldom regular, and when that is the case she suffers ing tend to produce uterine inflammation, even when they occur great pain, and the hernia becomes purple. As the radical cure of hernia is now occupying the attention in temperate climates. The frequent liability of the European of surgeons, could not something be done to relieve such a to some form of intermittent or remittent fever was insisted on, as well as the fact that these affections sought out the case ? weakest organ, increasing its tendency to congestion and inflammation. Another cause of uterine inflammation was found THE EFFECTS OF THE PERCHLORIDE OF IRON. in that anaemia and intense debility which usually followed a THE influence of this powerful styptic was well shown in the prolonged residence in a tropical climate. arrest of dangerous haemorrhage from the tonsils, in a case The progress of inflammation of the womb, in Europeans, which we noticed in our " Mirror" of the 19th November last, during their residence in tropical climates, was described as under Mr. Henry Thompson’s care at the Marylebone Infir- unusually rapid, owing to the patients remaining subject to mary. We have seen it used at University College Hospital those climatorial influences which had produced the disease. for the coagulation of the blood in varicose veins, but in one The pathological conditions of those who return to Europe instance it produced suppuration over the vein and much con. from the tropics on account of uterine disease were next institutional disturbance. It has been employed by Mr. Prescott quired into. The inflammatory lesions, as well as the general Hewett, at St. George’s Hospital, upon a mass of veins situated symptoms, were represented as unusually severe, considering on the inner ankle of a young woman, with partial benefit; the duration of the complaint. It was stated that, even after but the veins were large, and difficult to reduce either in num- their return to England, the march of uterine inflammation is ber or bulk. In the same hospital we saw, on the 22nd ult., often complicated by partially subdued tropical complaints, an infant who had a large congenital nasvus of the left cheek. such as ague, remittent fever, liver derangement, and chronic This had been treated by the injection of the perchloride of dysentery. These complications were spoken of as interiron by a general practitioner out of the hospital, but with the fering with the treatment of the case, and protracting it much effect of producing the most intense inflammation, and slough- beyond its usual duration ; the uterine inflammation requiring ing of the central portion of the nsevus right down to the surgical treatment, in accordance with the principles laid down mucous membrane. Mr. Hewett has completely obliterated all in the author’s and in Dr. H. Bennet’s work on "Uterine the vessels of this nsevus by a series of operations, which con- Inflammation," without, however, neglecting to take into sisted in the passage of needles through its various parts, for serious account those complications which frequently arise, or the purpose of pressure and strangulation. The cure has been that deep-rooted debility which seems to be sometimes the ’ a tedious one, but nevertheless satisfactory. only reason why the patient will not rally, although judiciously The perchloride of iron would seem to be beneficial in some treated. cases when it is introduced subcutaneously, but in others it Dr. Tilt concluded by observing that he had sometimes seen sets np some amount of inflammation, which may so impair young women taken to India in whom the menstrual flow was the vitality of the parts as to produce actual destruction of so irregular as to preclude the possibility of health being long tissue, as occurred in the last-mentioned instance. It requires preserved in a tropical climate; that he had attended patients to be used with care. whose health had been ruined by too long a stay in India, after uterine disease had become severe; and others who, THE MORTALITY ON BOARD THE " AcCBINGTON."— having returned to India before they were quite cured of an Subsequent letters seem to confirm the reports of sinister deal- inflammatory affection of the womb, were soon obliged to come ings on board this ship, in which the mortality amongst the home on account of a severe relapse of the uterine complaint : Letters have been and this led him to recommend the following practical rules women and children has been horrible. published complaining of shameful barbarities. Fifty-six of relative to the prevention of uterine inflammation amongst the children died, " and mainly owing to the inattention of Europeans in tropical climates :the doctor, who was known to be drunk for four days to1. Those in whom the menstrual flow is habitually morbid gether, and not able to attend upon the poor sufferers. The in a temperate climate should not settle in a tropical region. 2. Those who have frequently suffered from inflammatory captain and chief mate, accused of infamous cruelties, have been poisoned." We earnestly trust that further investigation uterine affections in a temperate climate should not settle in & tropical region. may release the surgeon from the charges alleged against him.
63
severity. Appetite good. July 2nd.-Bowels have
not been relieved since the 30th.
but the forefingers and thumbs cannot be used. She of course gave up her old occupation when she first came under treat. ment. Her general health has always been good. A short time back we saw a case under Mr. Erichsen’s care, at University College Hospital, of a man who had temporary paralysis of the supinators of his right forearm, from the constant use of tailors’ shears.
GOITRE SUCCESSFULLY TREATED BY LARGE DOSES OF BROMIDE OF POTASSIUM AND LIQUOR POTASSÆ. CASES of goitre, and especially those of long standing, are some of the most troublesome and unsatisfactory that fall
under the notice of practitioners. In many of them, even where treatment has been successful for a time, it sometimes happens that from very trifling exciting causes the gland enlarges to as great a size as ever. During the past year we had the oppor. tunity of seeing over a dozen examples of goitre, under Dr. O’Con. nor’s care at the Royal Free Hospital. In a few of those cases, iodide of potassium, in small doses, gradually increased to much larger ones, with the external application of strong iodine paint, was tried without benefit. The same remedies in combination with steel, and generous living, were equally unsuccessful. Bromide of potassium, in doses of five grains, with ten minims of liquor potassae in infusion of quassia, was next tried, and continued for some time, with benefit, the bromide being gradually increased to doses-of twenty.five grains, three times a day, with forty minims of liquor potassse. In all the instances in which it was given for a proper length of time, the result was a complete disappearance of the glandular enlargement. The minimum dose of the bromide now administered in these cases by Dr. O’Connor is ten grains, with twenty minims of liquor potassse and infusion of quassia. There are now three patients under treatment in whom the progressively beneficial effects of this remedy are clearly discernible. In many of these cases strong iodine paint is used We have heard Dr. O’Connor state, that as an application. the bromide of potassium does not produce any of the depress. ing effects of the iodide, which is a practical point of very great
He does not feel much pain; appetite good; urine still scalds very much; sleeps well. To have half a drachm of acetate of
potass in an infusion of quassia thrice a day. 5th.-Has a little pain occasionally in the left groin; tongue clean; the pain on micturition continues; urine rather deficient
ih’quantity.
7th.-He has passed more urine, and. does not suffer from any pain whatever, but feels weak. Appetite good. 9th.-Left the hospital yesterday. Blue line on the gums much diminished.
CLINICAL
RECORDS.
importance. BRONCHOCELE COMMON TO MANY OF THE ENGLISH COUNTIES. THE name of Derbyshire neck used to be given to goitre, or enlargement of the thyroid glands, from the remarkable prevalence of the affection at one time in the county of Derby. This malady is, however, met with sporadically in other counties. Thus some of the cases which we have seen at the Royal Free Hospital were from Kent, Surrey, Bedford, &c.; and we lately saw one, under Dr. Willshire’s care, at the Charingcross Hospital, from Hampshire, the patient being a woman of about twenty-two years of age, who was born and brought up in that county. She had a very large bronchocele extending to both sides of the neck, and was given three or four gains of iodide of potassium, with twenty minims of the tincture of iodine during the day, iodine being used externally as well. It is probable she might have improved had her health not otherwise given way. She was a stout woman, with a ruddy complexion, accustomed to much exercise, and the mere change from country to town air evidently disagreed with her, for she became pale, and the catamenia ceased, whilst under treatment. She, therefore, left the hospital, and returned to her native county. It would appear that the great majority of cases of bronchocele met with in London come from the metropolitan counties.
PALSY AND WASTING OF THE FLEXORS OF THE FOREARM. FROM HAT-PRESSING. IN wrist-drop, or palsy of the forearm and hand, in who are subject to the poisonous influence of lead, the extensor muscles are chiefly affected, and wrist-drop is the result. The fingers are seen to be flexed upon the hand, and the hand upon the forearm. The affection is a peculiar one, and not easily mistaken. We had the opportunity of seeing an opposite condition to the above at Guy’s Hospital, on the 6th December, in the person of a young woman, aged twenty-two years, whose occupation was that of a hat-presser. In her there was paralysis of the flexors of the forearm and hand, with wasting of the HÆMORRHAGE FROM THE REMOVAL OF . muscles. For five years, whilst employed in her avocation, DEAD BONE. this affection had been gradually coming on, and at last she IN the union of a severely comminuted and compound frac. had to give it up, as her hands and forearms were almost useless. When she first came under the care of Mr. Bryant, about ture, the normal position of parts will sometimes become the course of even one of the larger bloodvessels twelve months ago, the bones of the metacarpus could be plainly seen and felt in the palm, and the entire anterior aspect of the This is only to be discovered when any may be altered. forearm was shrunken and wasted. She could not flex the operation is subsequently required, such as the removal ofa hands upon the wrists, and could scarcely hold anything. piece of bone. An illustration in point was presented to Under the use of galvanism three times a week for nearly a our notice at St. George’s Hospital on the 22nd of December. was brought into the operating theatre with year, she can now, however, flex the wrist pretty freely, and An bone over the site of a fracture of the left tibia, which can grasp any substance with the fingers only, but the latter do not freely bend into the palm of the hand. The fleshy por- occurred two years ago. The bone was broken into several tion of the flexors of the forearm has, to some extent, regained pieces, and a wound communicated with the fracture. The its normal size, but the tendency of the hands and wrists is leg was carefully put up, and union ensued, with some slight to bend backwards. The backs of both hands appear natural, deformity, but ’nevertheless a good limb was saved. SOIl1e
persons
changed, and dead necrosed elderly man
62
dead bone remained, and was the cause of much trouble. Mr. Cassar Hawkins used the trephine, and removed the whole of it. It was necessary to employ the scalpel in reflecting back the tissues, and in doing this the anterior tibial artery was wounded; its course had somewhat deviated across the frac- ROYAL MEDICAL & CHIRURGICAL SOCIETY. ture, and it seemed to be lodged in a fossa formed by a proTUESDAY, JAN. 10TH, 1860. jecting piece of bone. Attempts were made to take up the vessel with the forceps, and to apply a ligature, but all were MR. F. C. SKEY, F.R.S., PRESIDENT. unsuccessful, until a square mass was dissected away and isolated, including the vessel, when a ligature, placed over all, OF TROPICAL CLIMATES ON THE RISE AND stopped further bleeding. The haemorrhage, however, was ON THE INFLUENCE PROGRESS OF INFLAMMATORY AFFECTIONS OF THE WOMB. most difficult to control until this process of isolation was adopted by Mr. Pollock. The patient is going on well, and BY E. J. TILT, M.D., M.R.C.P., free suppuration has been established. THE GENERAL
Medical Societies.
SENIOR PHYSICIAN TO
FARRINGDON
DISPENSARY
AND LYING-IN CHARITY.
HERNIA.
TUMID ABDOMEN WITH AN UMBILICAL OF all the varieties of hernia of the abdominal cavity, it is
THE scantiness of our information upon this point was first noticed by Dr. Tilt, whose attention had been drawn to it by having had to attend, during the last ten years, patients invalided by uterine inflammation, in the East or West Indies, in China, and Brazil. Proceeding to investigate the etiology of uterine disease amongst Europeans in tropical climates, Dr. Tilt took India as an example, and pointed out how, even if the menstrual function had been previously regular in young women going out to India, it became irregular from travelling and the sea voyage; how, without passing through a period of repose, on arriving in India, and before the menstrual function had had time to " right itself," these emigrants were launched into the fatigues and gaities of society, often marrying at too early an age, and even before menstruation had become regular. Dr. Tilt observed that, little accustomed to the heat of India, the inexperienced European often imprudently exposed herself, during the menstrual period, to the raw, chilly night air, or to the north-wester, or made too frequent a use of cold water at that time. The pathology of tropical climates was
somewhat rare to find the umbilical form come on late in life, unless the patient has been subject to it shortly after birth. Women who have had the abdomen frequently and greatly distended by giving birth to numerous children have become ruptured a little to one side of the umbilicus. There was very lately a female patient, forty-six years of age, in St. Bartholomew’s Hospital, under Dr. Farre’s care, the subject of an irreducible umbilical hernia for the last ten years. She is not the mother of a large family, but at the period mentioned she was greatly fatigued from nursing a little I boy ; this not unfrequently caused much straining, which I gave rise to the tumour. She was seen, at Dr. Farre’s request, by Mr. Lloyd, who found that nothing could be done in the way of reduction. This patient was admitted on Dec. 15th, with tumidity of the abdomen and constipation. With the exception of these symptoms, her health is pretty good, and she has long worn an abdominal belt. She is not, however, easy unless the bowels are moved some five or six times a day ; represented as being principally abdominal, Europeans becomoccasionally subject to liver disease and dysentery, which they are seldom regular, and when that is the case she suffers ing tend to produce uterine inflammation, even when they occur great pain, and the hernia becomes purple. As the radical cure of hernia is now occupying the attention in temperate climates. The frequent liability of the European of surgeons, could not something be done to relieve such a to some form of intermittent or remittent fever was insisted on, as well as the fact that these affections sought out the case ? weakest organ, increasing its tendency to congestion and inflammation. Another cause of uterine inflammation was found THE EFFECTS OF THE PERCHLORIDE OF IRON. in that anaemia and intense debility which usually followed a THE influence of this powerful styptic was well shown in the prolonged residence in a tropical climate. arrest of dangerous haemorrhage from the tonsils, in a case The progress of inflammation of the womb, in Europeans, which we noticed in our " Mirror" of the 19th November last, during their residence in tropical climates, was described as under Mr. Henry Thompson’s care at the Marylebone Infir- unusually rapid, owing to the patients remaining subject to mary. We have seen it used at University College Hospital those climatorial influences which had produced the disease. for the coagulation of the blood in varicose veins, but in one The pathological conditions of those who return to Europe instance it produced suppuration over the vein and much con. from the tropics on account of uterine disease were next institutional disturbance. It has been employed by Mr. Prescott quired into. The inflammatory lesions, as well as the general Hewett, at St. George’s Hospital, upon a mass of veins situated symptoms, were represented as unusually severe, considering on the inner ankle of a young woman, with partial benefit; the duration of the complaint. It was stated that, even after but the veins were large, and difficult to reduce either in num- their return to England, the march of uterine inflammation is ber or bulk. In the same hospital we saw, on the 22nd ult., often complicated by partially subdued tropical complaints, an infant who had a large congenital nasvus of the left cheek. such as ague, remittent fever, liver derangement, and chronic This had been treated by the injection of the perchloride of dysentery. These complications were spoken of as interiron by a general practitioner out of the hospital, but with the fering with the treatment of the case, and protracting it much effect of producing the most intense inflammation, and slough- beyond its usual duration ; the uterine inflammation requiring ing of the central portion of the nsevus right down to the surgical treatment, in accordance with the principles laid down mucous membrane. Mr. Hewett has completely obliterated all in the author’s and in Dr. H. Bennet’s work on "Uterine the vessels of this nsevus by a series of operations, which con- Inflammation," without, however, neglecting to take into sisted in the passage of needles through its various parts, for serious account those complications which frequently arise, or the purpose of pressure and strangulation. The cure has been that deep-rooted debility which seems to be sometimes the ’ a tedious one, but nevertheless satisfactory. only reason why the patient will not rally, although judiciously The perchloride of iron would seem to be beneficial in some treated. cases when it is introduced subcutaneously, but in others it Dr. Tilt concluded by observing that he had sometimes seen sets np some amount of inflammation, which may so impair young women taken to India in whom the menstrual flow was the vitality of the parts as to produce actual destruction of so irregular as to preclude the possibility of health being long tissue, as occurred in the last-mentioned instance. It requires preserved in a tropical climate; that he had attended patients to be used with care. whose health had been ruined by too long a stay in India, after uterine disease had become severe; and others who, THE MORTALITY ON BOARD THE " AcCBINGTON."— having returned to India before they were quite cured of an Subsequent letters seem to confirm the reports of sinister deal- inflammatory affection of the womb, were soon obliged to come ings on board this ship, in which the mortality amongst the home on account of a severe relapse of the uterine complaint : Letters have been and this led him to recommend the following practical rules women and children has been horrible. published complaining of shameful barbarities. Fifty-six of relative to the prevention of uterine inflammation amongst the children died, " and mainly owing to the inattention of Europeans in tropical climates :the doctor, who was known to be drunk for four days to1. Those in whom the menstrual flow is habitually morbid gether, and not able to attend upon the poor sufferers. The in a temperate climate should not settle in a tropical region. 2. Those who have frequently suffered from inflammatory captain and chief mate, accused of infamous cruelties, have been poisoned." We earnestly trust that further investigation uterine affections in a temperate climate should not settle in & tropical region. may release the surgeon from the charges alleged against him.
63