ROYAL ARSENAL HOSPITAL, WOOLWICH.

682 the catheter. In the evening he was still further collapsed; the skin was cold and moist, and the pulse imperceptible. During the night he was very restless, and next morning his condition, both locally and constitutionally, was much worse; the swelling had passed into the perineum, and that of the penis and scrotum had increased. Gangrene of the parts first affected had evidently taken place. A very little, if any, urine had been passed during the night. An erysipelatous redness was extending over the pubes and abdomen. Tonguewasfurred and dry; surface cold and clammy ; no pulse. A catheter was passed, but no urine was found in the bladder. Several Lawson then saw the patient, and amputated the thumb incisions were made into each side of the penis, scrotum, after he was put under the influence of chloroform. The and perineum, giving exit to a large quantity of serum. patient inhaled nearly four ounces of chloroform before he Two incisions were also made into the abdominal wall where the erysipelas appeared, but the circulation was so feeble was well under its influence, and even then his limbs were that blood hardly flowed from them. In the evening the Before from the chloroform was the awaking patient rigid. of with half acetate a of the swelling was much less in consequence of the continuous injected subcutaneously grain morphia. Under the combined effect of the chloroform and drain of serum which had taken place from the incisions. the morphia the patient was quiet for nearly three hours. There was no urine in the bladder. The state of collapse was At a quarter to three o’clock the convulsions recurred. The profound, and the man was delirious and very restless, first convulsion was at about a quarter to three o’clock ; the This condition lasted until 1 A.M., when he died exhausted. second at half-past three ; the third at a quarter-past four ; The treatment had consisted in efforts, by means of warmth the fourth at about a quarter to five. From this time the and stimulants, to combat the state of collapse which was convulsions were repeated every ten or fifteen minutes, and well-marked even on admission, but which, notwithstanding he died in one of them at ten minutes to ten on Sunday all endeavours to the contrary, increased up to the time of his death, about fifty-hours after the strain was supposed morning. The treatment during the short time the patient was in the to have occurred. Opium was given internally and fomen. hospital was as follows : Soon after admission he was injected tations used locally. On post-mortem examination, the internal organs were subcutaneously with the one-sixteenth of a grain of the extract of Calabar bean, and this was repeated in about one found healthy; there were some old pleuritic adhesions in hour. Finding no relief, a third of a grain of the acetate of the right side of the chest. The bladder was healthy and morphia was injected subcutaneously. The injured thumb quite empty; the urethra was healthy in appearance, except towards the outer end, where, for about one inch, there was was then amputated, and whilst the patient was under the influence of chloroform he was injected with half a grain of some ecchymosis. The cellular tissue of the penis and scrotum was infiltrated with serum ; the body of the penis the acetate of morphia. was distended with dark blood, which oozed out on section from the notes of examina(abstract post-mortem Necropsy tion made by Dr. Fowler). -Thorax : Organs healthy ; of the corpora cavernosa ; the tunica vaginalis contained fluid. That such a condition should have ori. some post-mortem congestion. Kidneys were enlarged, con- very little in a strain, such as described, would seem strange. ginated off and on indurated ; capsule adherent ; stripping gested, the capsule a granular surface was left, but no wasting of A witness at the inquest which took place stated that the cortex. Brain : Vessels (veins) of meninges over occipital tent-pole fell between the man’s legs. If this occurred, the man himself denied, possibly the penis received region were full of blood (post mortem). On removing the which membranes no marked changes were seen in the pia mater a contusion at the situation of the ecchymosis found in the urethra, causing rupture of some of the vessels in the corpora or convolutions. On sections being made through the brain, cavernosa, resulting in such distension of those organs as to no decided changes could be detected with the naked eye. There were some post-mortem coagula in the lateral sinuses. interfere to such an extent with their circulation as to The base was unchanged. Cord : Membranes showed some bring on gangrene of the penis, which spread backwards to

costals, and probably the diaphragm, were in a state of strong spasm, as respiration during the attacks was arrested, and the face and surface became of a dark-bluish colour. The flexors of the forearm were free from spasm. Thee attacks came on about every half-hour, some being more severe than others. At about 11P.M. he had a most severe attack ; his muscles of respiration were involved ; he ceased to breathe, his heart and pulse stopped, and the patient was black in the face, when, with a sudden bound, the pulse began again, and he recovered for the time. In this attack his tongue was caught between his teeth, and almost bitten in two. Mr.

post-mortem congestions, otherwise they

were

the

healthy.

There was an enormous number of calcareous patches in the membranes, extending from abovethe cervical to below the lumbar enlargement; but beyond this nothing abnormal was detected.

neighbouring parts.

MANCHESTER ROYAL INFIRMARY. CASE OF POPLITEAL ANEURISM ; RUPTURE INTO KNEEJOINT; AMPUTATION THROUGH THE THIGH; RECOVERY.

(Under the care of Mr. WHITEHEAD.) FOR the following notes we are indebted to Mr. G. CASE OF TRAUMATIC GANGRENE OF THE PENIS Preston. AND SCROTUM ; NECROPSY. William B-, aged forty, a labourer, was admitted on (Under the care of Surgeon-Major W. F. STEVENSON.) Jan. 1st, 1883, suffering from aneurism of the left popliteal W. J-, a painter, married, aged forty-three, was adartery. His previous history was as follows : About seven mitted into hospital on Jan. 3rd, 1883, with great swelling months ago the patient’s left leg was crushed just below the and ecchymosis of the penis and scrotum, but not extending knee. The joint, he says, was severely strained by the into the perineum. He stated that on the previous day he accident, but it was not so badly hurt as to keep him from had strained himself while at work by attempting to sup- his work. On the following morning he noticed a small port a tent-pole (weighing thirty pounds) which was falling lump, about the size of a marble, at the lower part of the on him, but that he did not fall and did not receive any blow popliteal space. He suffered no pain in it; but still he con. sidered it advisable to stay at home that day and rest his He suffered considerable or direct violence of any kind. On the next day, the second after the accident, he leg. at work the afternoon. went to his work as during pain at first, but remained usual, and for fourteen days he noticed When he went home he applied fomentations. nothing further as regards the lump, but at the end of this On admission, at 10.30 A.M., the scrotum was as large as term he experienced some slight pain when walking or when an infant’s head from effusion of serum into the cellular he tried to extend his leg fully. On examining the swell. tissue, and the penis much enlarged from the same cause ; ing he found that it had increased to the size of a hen’s egg. these parts were also almost black from ecchymosis. The Though the patient still went on with his work, the conperineum was not aflected. There was not much pain. On dition of his leg remained the same up to a week before his the left side of the penis the cuticle had been removed from admission, when he sustained what he describes as another a piece of skin about the size of a half-crown, and a thin strain of the same knee ; by the following day the swelling The man looked very ill ; he was had increased considerably in size, and he suffered great grey slough remained. pale and cold ; the pulse weak and 136 ; he had voided water pain in the knee and down the leg. He stayed in bed and freely during the night, and stated that it contained blood. applied hot fomentations and poultices to the swelling, the A catheter (No. 10) was passed with ease, and a small result being a gradual increase in the size of the swelling quantity of urine containing no blood was drawn off. During and an increase in the pain. He now, for the first time, the day he passed a very little clear urine without the use of consulted a medical man, who sent him to the hospital. ROYAL ARSENAL

HOSPITAL, WOOLWICH.

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