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ON A CASE OF IMPERFORATE ANUS.
351 was very poorly afterwards; but subsequently rallied. Armstrong has since diligently employed mechanical dilatation, introducing a bougie daily, and gradually increasing the size. He informs me that at the present date (March 5) "the child is much improved in appearance, and is obviously gaining flesh. The water is passed freely, and the bowels are moved about three times each day, the motions being consistent, and of a good colour, free from mucus or blood. A bougie, rather exceeding an inch and a half in circumference, (about half an inch in diameter,) is passed up with great ease." Further on Mr. Armstrong adds,-" I made a careful examination of the rectum with my finger, which I was able to pass with very little difficulty. I found that the hard, dense, almost
and Mr.
are always more or less flattened, and present no trace of striao or stripes, although the interior appears granular, with an occasional nucleus. The heart is a remarkable exception to this rule, being an involuntary organ, with mixed fibres differing in size, and resembling in tim respect those of a voluntary muscle. The peritonseal coat is formed of the white fibres, under a structureless or basement membrane, covered by tesselated epithelium, constituting a serous and secreting membrane, on which I need not dwell.
size,
(To be continued.)
cartilaginous structures which you felt and incised, when I had the pleasure of meeting you before, had greatly diminished, and instead of resisting the admission of the point of the little BY F. LE GROS CLARK, ESQ., F.R.C.S. ASSISTANT-SURGEON TO, AND LECTURER. ON ANATOMY AT, ST. THOMAS’S finger, the bowel now admits the whole finger readily. The HOSPITAL. strictured portion is also dilatable, and the surrounding texON Jan. 20th, 1851, I was called to the neighbourhood of tures are soft, elastic, and yielding. Absorption is evidently Gravesend to see a newly-born infant, who was the subject of going on; and the surface feels soft, as if something like a imperforate anus. I met Mr. Armstrong, of the above town, mucous membrane were being formed upon it. There seems with whom I had the pleasure of acting throughout the treat- every reasonable hope that the case will terminate in a perfect cure." ment of the case. The child, a male, was well developed, and apparently perRemarks.-My reason for desiring to place the foregoing fect in every respect: for the anus presented a natural appear- case on record is, not because it is unique, or even, pathoance, and was pervious to the extent of about half an inch, logically, of rare occurrence, but because I regard it as belongand sufficiently capacious to allow the introduction of the little ing to a class of cases in which precedents are peculiarly finger. On reaching the extremity of this cul-de-sac, (for such valuable, as affording encouragement and supplying a ground it proved,) the finger was arrested by a firm, unyielding, mem- of justification for making a bold attempt to save life. I am branous obstruction, against which not the slightest impulse aware that these remarks do not apply where consultation is could be felt, when the abdomen was pressed upon, or when readily available, and where responsibility may be shared; the child cried. The infant was at this time barely two days but to some provincial practitioners, to whom these advantages old; but as it was evidently beginning to suffer from general are denied, precedents in a case which may occur to them distress, and rejected everything that was taken into the but once in their lives must, or ought to, have their value. stomach, it was deemed desirable at once to take some steps There is, moreover, but little risk of boldness in this instance for its relief. degenerating into rashness-an observation which is of rare The child was held on the nurse’s lap, with the nates rest- application in surgical practice, and I apprehend there are ing on her knees. Using my left fore-finger as a guide, I in- few who will deny that many infants, similarly circumstanced troduced along it a straight narrow bistoury, with which I to that which forms the subject of this case, have been suffered perforated the obstructing membrane, and then passed the to perish for want of decisive measures for their relief. It is not my intention or desire to enter upon this subject knife upwards and backwards to the extent of an inch or at large. Suffice it to remark, that all cases of imperforate more in the median line. Some venous blood but no meconium followed. I then introduced a director, but still no meconium anus may be classed under two heads-those which may be could be detected. A slight impulse, however, was felt relieved by an operation similar to that detailed above, and. against the end of the director when it was pressed firmly up- those in which the imperfection of development precludes the wards, and counter-pressure was applied to the abdomen. I possibility of reaching the bowel from the anus. In the latter regarded this as a doubtful evidence of an approach to the in- class of cases an artificial anus is the only alternative, and this testine ; certainly as not possessing the same diagnostic value may be made in the groin or lumbar region. The alternative, even if successful, is a miserable one; and the statistics of as a more general impulse and fulness would afford, when felt on the surface by the finger. Yet, as there seemed to be no such cases are not of a very satisfactory nature, even as regards alternative but the miserable one of abandoning the child, or the protraction of life. The reader will find some statistics on that of making an artificial anus, I again took the bistoury, this subject, collected in a valuable paper by Mr. Phillips, on. and guided it along the director upwards, backwards, and a " Intestinal Obstructions," in the thirty-first volume of the little to the left side, to the extent of another inch. On with- -4fedico-Cltirtirgical Transactions. Of the former, or curable, drawing the two instruments together, meconium followed in class of cases,twoforms present themselves-those in which the abundance, with very little blood. The little finder could gut is reached by simply incising the integuments or occluding now reach the bowel. The relief was immediate, and the first membrane, and those (like the present) where the rectum meal, taken half an hour afterwards, was retained on the stops considerably short of its proper termination. I have stomach. It was thought advisable, as the opening was a free operated in one instance where 1 found the anus entirely one, not to interfere at first by the use of tents or bougies. wanting; and though in this case the superficial structures The case went on uninterruptedly well for more than a requiring division were about half an inch in thickness, the week, the motions being passed freely and easily, as Mr. Arm- fluctuating bulging at the proper spot satisfied me of the strong reported to me; and the state of the child was in every proximity of the intestine. Nature, almost unaided, comrespect so satisfactory, that he did not consider himself justi- pleted the cure. fied in interfering locally, until, on the evening of the 28th, I propose briefly, in conclusion, to point out the practical sickness and straining, without relief from the bowels, led him inferences to be drawn from the case recorded in this comto make an examination, when he found the artificial opening munication. I believe the best instrument for opening the so far closed as to render the introduction of a No. 8 urethral bowel to be that which I employed-viz., a straight, narrow bougie difficult. The size of the bougie was subsequently in- bistoury, and the best guide to be the finger, as far as it can reach. Though prepared with a trochar and canula, I precreased. Though some relief was thus obtained, the progress of the ferred, in the second and deeper i-ncision, using a director and the straight knife. At first I cut in the median line, keeping case was so far from satisfactory, that Mr. Armstrong requested another consultation with me; and I accordingly met near to the sacrum: but in carrying the incision deeper, I felt him on Feb. 6th. On examination with the little finger, the the propriety of directing the knife a little to the left side, m aperture of communication with the bowel could scarcely be order to meet the corresponding inclination of the rectum in detected, although a No. 12 urethral bougie could be forcedI the upper part of its course. The full depth to which the through it. The fresh production which now constituted the knife was passed before the bowel was fairly opened (including obstruction seemed to be of that solid character which yielded the half inch of cul-de-sac) must have been two inches and a by elasticity to the gradual dilating force of the conical bougie, half. I rather dreaded the possible loss of blood, but tha and again closed when it was withdrawn. I introduced a result proved that this fear was ungrounded. The communidirector, and divided this obstructing mass with a common cation with the bowel being free, I considered it advisable to hernia-knife, backwards and on either side, to as great an ex- allow a short interval to elapse before any mechanical measures. tent as I deemed safe; and then relieved the bowels by intro- were resorted to for securing the permanency of the opening. ducing a pair of dressing forceps and opening the blades. The In a similar case it would, probably, be desirable not to allow child lost a little blood at the time of this second more than two, or at most three, days to elapse without the ON A CASE OF IMPERFORATE ANUS.
I
operation,I
352 Since writing the above, I have noticed there is in the last employment of dilatation; and I should give the preference to bougie over any other July number of the American Journal of Medical Science a. a well constructed and rather conical instrument: the latter progress of the case proves that such parallel case to the foregoing, where the unfortunate female an instrument is sufficient for the re-establishment of the lost her life simply through the hymen not being divided, as almost closed opening. I proposed the use of a gum-elastic the post-mortem revealed;-"the uterus and vagina being tube, to be constantly worn; and such an one was con- immensely distended, as well as the Fallopian tubes, with structed ; but the satisfactory progress of the case, under the dark, inodorous fluid." It is stated, that "a consultation by use of the bougie, superseded the necessity for its employment. two or three professed surgeons" was held respecting the proOne further remark I would make, which, indeed, could not priety of operating in this melancholy and most shamefully but force itself upon my attention,-I mean, the importance of treated case, but they decided against it. Culpahle as our keeping the bowels in a relaxed state whilst there exists any government is for its toleration, or rather patronage, of tendency to contraction. Fortunately, constipation is not quackery, and its carelessness of human life, surely such an common at this early age; but I felt that, at one period, it instance of criminal ignorance as this, were it to become would probably have proved fatal in this case. I cannot form known, would not escape condign punishment. Llanfair, Montgomeryshire, Jan. 1851. any idea, from examination, of the nature of the tissues I cut through at first; but I apprehend they must have been of a condensed areolar charétcter.
The
dense structures
which
required subsequent incision were clearly the product of ON A CASE OF ELEPHANTIASIS SCROTI. inflammation; their gradual removal under the employment of the bougie is an encouragement to be satisfied with similar BY F. GODFREY, ESQ., treatment under parallel circumstances. E.I.Co’s SERVICE, MADRAS. SUPERINTENDING-SURGEON, I need scarcely add how much of the success in this case is Mr. of due to the judgment and attention my coadjutor, LAZARUS IIŁŁ,an East Indian, aged tlirty, resident at St. Armstrong. London, March, 1851. ON A CASE OF
OBSTRUCTION TO MENSTRUATION BY AN IMPERFORATED HYMEN. WITH REMARKS ON THE PREVALENCE OF
BY J.
QUACKERY IN WALES.
JONES, ESQ., Surgeon, Llanfair.
WAS requested in December, 1849, to attend a female, aged nineteen, who was represented to be suffering from intense abdominal pain and swelling. On visiting the patient, I found her apparently in the agonies of labour, the abdomen being enormously distended, but soft, and wanting that hard feel so
I
I
characteristic of pregnancy at the full period. The vagina was occupied by what I at first supposed to be the membranes of the ovum, so tense and stretched as to be almost ready to burst; but a moment’s further examination assured me that there was complete occlusion of the vagina by an imperforate hymen or some adventitious membrane. I forthwith plunged an abscess lancet through this membrane, when a treacle-like, inodorous fluid instantly issued forth, with such force as to squirt over myself and the by-standing attendants, and which in a very short time deluged the bed. Relief was instantaneous. The discharge continued in a stream for about an hour, when it gradually almost ceased. I afterwards further divided the hymen, which I found the obstruction reilly to be; and I left my patient with injunctions that she should be kept quiet for a few days, and that an aperient should be given her on the morrow. Three days subsequently I heard she was convalescent, and she has enjoyed good health since. I may add, that previous to my being called to this female, she had been for some days attended by an irregular practitioner. Had her death occurred while under his hands, there would have been no inquest, no post-mortem examination, and theaffair woald have been passed overasa case of ordinary death. There can be no conception of the deaths, or rather murders, occurring, under circumstances akin to this, but which never It is come to light in Wales, where quackery is rampant. not uncommon in this country for dissenting ministers to practise physic; they traverse the whole principality, pretending to be curers of both bodies and souls, and our benighted, credu’ous peasantry, believing them to receive both missions by inspiration, believe also, of course, that they can do no but are more likely to confer benefit than a person scientifically educated," which means, in their apprehensions, edu- i cated merely in worldly wisdom." ’ I know one celebrated character of this class, whose way of is the to work himself following:ŁHe gets proclaimed going to preach in a certain neighbourhood on a Sunday, and it is a publicly understood matter that he will be accessible for consultation during the following Monday. He accordingly en-
injury,
gages an apartment at an inn, or some place most convenient, where all who wish the benefit of his advice are desired to meet. He finally examines and prescribes for each individual, and for every prescription demands one shilling, but any larger sum is not declined. This worthy, although most illiterate, and ignorant of medical science, makes hundreds a year in this way. It is no credit to the respectable Christian body of whom he is minister, the Welcla Calvinistic Metliodists, that they tolerate such proceedings among them.
Thonte, in the surburbs of Madras, by trade a tanner, ten years married, and for the last nine has been afflicted with elephantiasis scroti, during which period has not had the least sexual desire. The tumour is of immense size, hanging down nearly to the level of the ankles, and causing him by its bulk and weight great difficulty in moving about. The following are the dimensions, as taken in the erect position: length from superior to inferior part twenty-six inches; circumference, one yard and a half; general shape ovoid; feels dense, brawny, osdematous, and, on percussion, some deeply seated fluctuation is perceptible; the surface is not warty, (as frequently observed,) but studded with small superficial ulcerations, which itch, smart, and prevent sleep; the prasputial opening on the anterior surface, is about ten inches below the pubes; rather singular in appearance, being of an archshaped figure, (convexity upwards,) with a strong, wellmarked vertical line formed by the fraenum, extending from the concavity continuously downwards to the rapl,.6; this opening readily admits the finger, and on introducing a. rounded piece of wood to the extent of ten inches, (not having a probe of sufficient length,) the patient was conscious of its touching the penis. On proposing to remove the tumour by operation, he readily assented, saying that it rendered life miserable and burthensome to him; he was removed in a bandy to the Vepery Dispensary, (October 14th, 1850,) for greater convenience of operation, subsequent treatment, and for the benefit of the able assistance of Dr.
Kellie, Surgeon
of the Institution.
Chloroform
was
adminis-
to the extent of half an ounce, which produced only a violent and uproarious state of drunkenness; the operation was therefore deferred, as it appeared probable (from the man’s habits) he had been drinking, and which, on further inquiry, proved to be the fact. On the subsequent day, (October 15th,) the patient was again placed on the operating table, and two drachms of chloroform produced perfect anaesthesia. It had been previously determined on not to at. tempt the preservation of the testes, which would protract, not only the operation, but increase the chance of fatal termination; moreover, the total want of venereal desire for so many years seemed almost conclusive as to the degeneration or atrophy of these organs; it need scarcely be said that they could not be distinguished by any external examination; the groins had also been carefully examined with reference to the chance of rupture, and though this complication did not appear to exist, yet the thickened state of parts made the examination uncertain, and rendered caution in this respect necessary. The operation was performed in the following manner:-on a, The patient being on his back, and the tumour small table, about eight inches lower than the body, a piece of£ stick (by a way of a director), about half an inch in diameter, flattened on its upper surface, was passed into the prssputia.1 opening to the extent of ten inches, and the thickened intervening mass divided until the glans penis became distinguishable; the bleeding was rather free, but venous. Division of the integuments was then made, about an inch deep and seven or eight inches in length, obliquely from the outer part of the right groin, which extended to and joined the upper end of the first incision. Several small arteries were divided, and quickly ligatured. The cord could be felt rather deep, and the non-existence of rupture satisfactorily ascertained.
tered,
supported
and Mr.
are always more or less flattened, and present no trace of striao or stripes, although the interior appears granular, with an occasional nucleus. The heart is a remarkable exception to this rule, being an involuntary organ, with mixed fibres differing in size, and resembling in tim respect those of a voluntary muscle. The peritonseal coat is formed of the white fibres, under a structureless or basement membrane, covered by tesselated epithelium, constituting a serous and secreting membrane, on which I need not dwell.
size,
(To be continued.)
cartilaginous structures which you felt and incised, when I had the pleasure of meeting you before, had greatly diminished, and instead of resisting the admission of the point of the little BY F. LE GROS CLARK, ESQ., F.R.C.S. ASSISTANT-SURGEON TO, AND LECTURER. ON ANATOMY AT, ST. THOMAS’S finger, the bowel now admits the whole finger readily. The HOSPITAL. strictured portion is also dilatable, and the surrounding texON Jan. 20th, 1851, I was called to the neighbourhood of tures are soft, elastic, and yielding. Absorption is evidently Gravesend to see a newly-born infant, who was the subject of going on; and the surface feels soft, as if something like a imperforate anus. I met Mr. Armstrong, of the above town, mucous membrane were being formed upon it. There seems with whom I had the pleasure of acting throughout the treat- every reasonable hope that the case will terminate in a perfect cure." ment of the case. The child, a male, was well developed, and apparently perRemarks.-My reason for desiring to place the foregoing fect in every respect: for the anus presented a natural appear- case on record is, not because it is unique, or even, pathoance, and was pervious to the extent of about half an inch, logically, of rare occurrence, but because I regard it as belongand sufficiently capacious to allow the introduction of the little ing to a class of cases in which precedents are peculiarly finger. On reaching the extremity of this cul-de-sac, (for such valuable, as affording encouragement and supplying a ground it proved,) the finger was arrested by a firm, unyielding, mem- of justification for making a bold attempt to save life. I am branous obstruction, against which not the slightest impulse aware that these remarks do not apply where consultation is could be felt, when the abdomen was pressed upon, or when readily available, and where responsibility may be shared; the child cried. The infant was at this time barely two days but to some provincial practitioners, to whom these advantages old; but as it was evidently beginning to suffer from general are denied, precedents in a case which may occur to them distress, and rejected everything that was taken into the but once in their lives must, or ought to, have their value. stomach, it was deemed desirable at once to take some steps There is, moreover, but little risk of boldness in this instance for its relief. degenerating into rashness-an observation which is of rare The child was held on the nurse’s lap, with the nates rest- application in surgical practice, and I apprehend there are ing on her knees. Using my left fore-finger as a guide, I in- few who will deny that many infants, similarly circumstanced troduced along it a straight narrow bistoury, with which I to that which forms the subject of this case, have been suffered perforated the obstructing membrane, and then passed the to perish for want of decisive measures for their relief. It is not my intention or desire to enter upon this subject knife upwards and backwards to the extent of an inch or at large. Suffice it to remark, that all cases of imperforate more in the median line. Some venous blood but no meconium followed. I then introduced a director, but still no meconium anus may be classed under two heads-those which may be could be detected. A slight impulse, however, was felt relieved by an operation similar to that detailed above, and. against the end of the director when it was pressed firmly up- those in which the imperfection of development precludes the wards, and counter-pressure was applied to the abdomen. I possibility of reaching the bowel from the anus. In the latter regarded this as a doubtful evidence of an approach to the in- class of cases an artificial anus is the only alternative, and this testine ; certainly as not possessing the same diagnostic value may be made in the groin or lumbar region. The alternative, even if successful, is a miserable one; and the statistics of as a more general impulse and fulness would afford, when felt on the surface by the finger. Yet, as there seemed to be no such cases are not of a very satisfactory nature, even as regards alternative but the miserable one of abandoning the child, or the protraction of life. The reader will find some statistics on that of making an artificial anus, I again took the bistoury, this subject, collected in a valuable paper by Mr. Phillips, on. and guided it along the director upwards, backwards, and a " Intestinal Obstructions," in the thirty-first volume of the little to the left side, to the extent of another inch. On with- -4fedico-Cltirtirgical Transactions. Of the former, or curable, drawing the two instruments together, meconium followed in class of cases,twoforms present themselves-those in which the abundance, with very little blood. The little finder could gut is reached by simply incising the integuments or occluding now reach the bowel. The relief was immediate, and the first membrane, and those (like the present) where the rectum meal, taken half an hour afterwards, was retained on the stops considerably short of its proper termination. I have stomach. It was thought advisable, as the opening was a free operated in one instance where 1 found the anus entirely one, not to interfere at first by the use of tents or bougies. wanting; and though in this case the superficial structures The case went on uninterruptedly well for more than a requiring division were about half an inch in thickness, the week, the motions being passed freely and easily, as Mr. Arm- fluctuating bulging at the proper spot satisfied me of the strong reported to me; and the state of the child was in every proximity of the intestine. Nature, almost unaided, comrespect so satisfactory, that he did not consider himself justi- pleted the cure. fied in interfering locally, until, on the evening of the 28th, I propose briefly, in conclusion, to point out the practical sickness and straining, without relief from the bowels, led him inferences to be drawn from the case recorded in this comto make an examination, when he found the artificial opening munication. I believe the best instrument for opening the so far closed as to render the introduction of a No. 8 urethral bowel to be that which I employed-viz., a straight, narrow bougie difficult. The size of the bougie was subsequently in- bistoury, and the best guide to be the finger, as far as it can reach. Though prepared with a trochar and canula, I precreased. Though some relief was thus obtained, the progress of the ferred, in the second and deeper i-ncision, using a director and the straight knife. At first I cut in the median line, keeping case was so far from satisfactory, that Mr. Armstrong requested another consultation with me; and I accordingly met near to the sacrum: but in carrying the incision deeper, I felt him on Feb. 6th. On examination with the little finger, the the propriety of directing the knife a little to the left side, m aperture of communication with the bowel could scarcely be order to meet the corresponding inclination of the rectum in detected, although a No. 12 urethral bougie could be forcedI the upper part of its course. The full depth to which the through it. The fresh production which now constituted the knife was passed before the bowel was fairly opened (including obstruction seemed to be of that solid character which yielded the half inch of cul-de-sac) must have been two inches and a by elasticity to the gradual dilating force of the conical bougie, half. I rather dreaded the possible loss of blood, but tha and again closed when it was withdrawn. I introduced a result proved that this fear was ungrounded. The communidirector, and divided this obstructing mass with a common cation with the bowel being free, I considered it advisable to hernia-knife, backwards and on either side, to as great an ex- allow a short interval to elapse before any mechanical measures. tent as I deemed safe; and then relieved the bowels by intro- were resorted to for securing the permanency of the opening. ducing a pair of dressing forceps and opening the blades. The In a similar case it would, probably, be desirable not to allow child lost a little blood at the time of this second more than two, or at most three, days to elapse without the ON A CASE OF IMPERFORATE ANUS.
I
operation,I
352 Since writing the above, I have noticed there is in the last employment of dilatation; and I should give the preference to bougie over any other July number of the American Journal of Medical Science a. a well constructed and rather conical instrument: the latter progress of the case proves that such parallel case to the foregoing, where the unfortunate female an instrument is sufficient for the re-establishment of the lost her life simply through the hymen not being divided, as almost closed opening. I proposed the use of a gum-elastic the post-mortem revealed;-"the uterus and vagina being tube, to be constantly worn; and such an one was con- immensely distended, as well as the Fallopian tubes, with structed ; but the satisfactory progress of the case, under the dark, inodorous fluid." It is stated, that "a consultation by use of the bougie, superseded the necessity for its employment. two or three professed surgeons" was held respecting the proOne further remark I would make, which, indeed, could not priety of operating in this melancholy and most shamefully but force itself upon my attention,-I mean, the importance of treated case, but they decided against it. Culpahle as our keeping the bowels in a relaxed state whilst there exists any government is for its toleration, or rather patronage, of tendency to contraction. Fortunately, constipation is not quackery, and its carelessness of human life, surely such an common at this early age; but I felt that, at one period, it instance of criminal ignorance as this, were it to become would probably have proved fatal in this case. I cannot form known, would not escape condign punishment. Llanfair, Montgomeryshire, Jan. 1851. any idea, from examination, of the nature of the tissues I cut through at first; but I apprehend they must have been of a condensed areolar charétcter.
The
dense structures
which
required subsequent incision were clearly the product of ON A CASE OF ELEPHANTIASIS SCROTI. inflammation; their gradual removal under the employment of the bougie is an encouragement to be satisfied with similar BY F. GODFREY, ESQ., treatment under parallel circumstances. E.I.Co’s SERVICE, MADRAS. SUPERINTENDING-SURGEON, I need scarcely add how much of the success in this case is Mr. of due to the judgment and attention my coadjutor, LAZARUS IIŁŁ,an East Indian, aged tlirty, resident at St. Armstrong. London, March, 1851. ON A CASE OF
OBSTRUCTION TO MENSTRUATION BY AN IMPERFORATED HYMEN. WITH REMARKS ON THE PREVALENCE OF
BY J.
QUACKERY IN WALES.
JONES, ESQ., Surgeon, Llanfair.
WAS requested in December, 1849, to attend a female, aged nineteen, who was represented to be suffering from intense abdominal pain and swelling. On visiting the patient, I found her apparently in the agonies of labour, the abdomen being enormously distended, but soft, and wanting that hard feel so
I
I
characteristic of pregnancy at the full period. The vagina was occupied by what I at first supposed to be the membranes of the ovum, so tense and stretched as to be almost ready to burst; but a moment’s further examination assured me that there was complete occlusion of the vagina by an imperforate hymen or some adventitious membrane. I forthwith plunged an abscess lancet through this membrane, when a treacle-like, inodorous fluid instantly issued forth, with such force as to squirt over myself and the by-standing attendants, and which in a very short time deluged the bed. Relief was instantaneous. The discharge continued in a stream for about an hour, when it gradually almost ceased. I afterwards further divided the hymen, which I found the obstruction reilly to be; and I left my patient with injunctions that she should be kept quiet for a few days, and that an aperient should be given her on the morrow. Three days subsequently I heard she was convalescent, and she has enjoyed good health since. I may add, that previous to my being called to this female, she had been for some days attended by an irregular practitioner. Had her death occurred while under his hands, there would have been no inquest, no post-mortem examination, and theaffair woald have been passed overasa case of ordinary death. There can be no conception of the deaths, or rather murders, occurring, under circumstances akin to this, but which never It is come to light in Wales, where quackery is rampant. not uncommon in this country for dissenting ministers to practise physic; they traverse the whole principality, pretending to be curers of both bodies and souls, and our benighted, credu’ous peasantry, believing them to receive both missions by inspiration, believe also, of course, that they can do no but are more likely to confer benefit than a person scientifically educated," which means, in their apprehensions, edu- i cated merely in worldly wisdom." ’ I know one celebrated character of this class, whose way of is the to work himself following:ŁHe gets proclaimed going to preach in a certain neighbourhood on a Sunday, and it is a publicly understood matter that he will be accessible for consultation during the following Monday. He accordingly en-
injury,
gages an apartment at an inn, or some place most convenient, where all who wish the benefit of his advice are desired to meet. He finally examines and prescribes for each individual, and for every prescription demands one shilling, but any larger sum is not declined. This worthy, although most illiterate, and ignorant of medical science, makes hundreds a year in this way. It is no credit to the respectable Christian body of whom he is minister, the Welcla Calvinistic Metliodists, that they tolerate such proceedings among them.
Thonte, in the surburbs of Madras, by trade a tanner, ten years married, and for the last nine has been afflicted with elephantiasis scroti, during which period has not had the least sexual desire. The tumour is of immense size, hanging down nearly to the level of the ankles, and causing him by its bulk and weight great difficulty in moving about. The following are the dimensions, as taken in the erect position: length from superior to inferior part twenty-six inches; circumference, one yard and a half; general shape ovoid; feels dense, brawny, osdematous, and, on percussion, some deeply seated fluctuation is perceptible; the surface is not warty, (as frequently observed,) but studded with small superficial ulcerations, which itch, smart, and prevent sleep; the prasputial opening on the anterior surface, is about ten inches below the pubes; rather singular in appearance, being of an archshaped figure, (convexity upwards,) with a strong, wellmarked vertical line formed by the fraenum, extending from the concavity continuously downwards to the rapl,.6; this opening readily admits the finger, and on introducing a. rounded piece of wood to the extent of ten inches, (not having a probe of sufficient length,) the patient was conscious of its touching the penis. On proposing to remove the tumour by operation, he readily assented, saying that it rendered life miserable and burthensome to him; he was removed in a bandy to the Vepery Dispensary, (October 14th, 1850,) for greater convenience of operation, subsequent treatment, and for the benefit of the able assistance of Dr.
Kellie, Surgeon
of the Institution.
Chloroform
was
adminis-
to the extent of half an ounce, which produced only a violent and uproarious state of drunkenness; the operation was therefore deferred, as it appeared probable (from the man’s habits) he had been drinking, and which, on further inquiry, proved to be the fact. On the subsequent day, (October 15th,) the patient was again placed on the operating table, and two drachms of chloroform produced perfect anaesthesia. It had been previously determined on not to at. tempt the preservation of the testes, which would protract, not only the operation, but increase the chance of fatal termination; moreover, the total want of venereal desire for so many years seemed almost conclusive as to the degeneration or atrophy of these organs; it need scarcely be said that they could not be distinguished by any external examination; the groins had also been carefully examined with reference to the chance of rupture, and though this complication did not appear to exist, yet the thickened state of parts made the examination uncertain, and rendered caution in this respect necessary. The operation was performed in the following manner:-on a, The patient being on his back, and the tumour small table, about eight inches lower than the body, a piece of£ stick (by a way of a director), about half an inch in diameter, flattened on its upper surface, was passed into the prssputia.1 opening to the extent of ten inches, and the thickened intervening mass divided until the glans penis became distinguishable; the bleeding was rather free, but venous. Division of the integuments was then made, about an inch deep and seven or eight inches in length, obliquely from the outer part of the right groin, which extended to and joined the upper end of the first incision. Several small arteries were divided, and quickly ligatured. The cord could be felt rather deep, and the non-existence of rupture satisfactorily ascertained.
tered,
supported