ROYAL LONDON OPHTHALMIC HOSPITAL, MOORFIELDS.

158 The instrument is an ingenious one, and is likely to be very generally used in the hospitals. A seaman aged fifty was admitted on the 23rd of May. ; About five years ago he grazed his face. The wound did not OF THE PRACTICE OF close, but an elevation of the skin remained resembling a pimple, with a slight moisture on the surface. This remained MEDICINE AND SURGERY stationary for about eighteen months, when it commenced to IN THE spread, and has continued to do so up to this time. At the time of his admission, the skin covering the lower eyelid, half HOSPITALS OF LONDON. the upper eyelid, and part of the right cheek, was destroyed; the sore measuring about three inches and a half from the exNulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum ternal angle of the eye to the edge of the sore on the nose, and et dissectionum historias, tum aliormn, tum proprias collect as habere, et inter about an inch and a half from above downwards. There was se comparare.-MORGAGANI De Sed. et Caus. Jtfoft., lib. iv. Prooemium. considerable discharge, thin and yellow in character. The sore in some parts was of great depth. At times he suffered He had been under treatsevere pain of a darting character. ROYAL LONDON OPHTHALMIC HOSPITAL, ment before, having had it burned by nitric acid, but does not MOORFIELDS. think he received any real benefit. On admission, he was COMPLETE LOSS OF AN EYE FROM THE LODGMENT WITHIN ordered opium lotion. Shortly afterwards, Vienna paste was IT OF A SPLASH FROM A BULLET AFTER IT applied over the deepest part of the sore, with a slightly beneficial effect. HAD STRUCK THE TARGET. A fortnight ago the gas cautery was applied, and has been (Under the care of Mr. GEORGE LAWSON.) repeated three times, with great benefit. The sore has conTHE following case is an illustration of a very severe form tracted very much-at least an inch and a half in its long, and of accident to which the markers at rifle-butts are exposed, inan inch in its transverse, diameter. It has a more healthy apand the discharge is lessened in quantity. The pain spite of the precautions which are taken to protect them from pearance, he suffers, independently of that proceeding from the cautery, the bullets of from lead are often detached danger. Splashes after they have struck the target; and these fly off with a is much less than it was. He is still under treatment. In this case both the flame and the heated platinum points velocity sufficient to inflict serious injury on the marker if have been used. The action of the flame is more prompt and have to come in In case we now contact with him. the they but is suited for in the immediate powerful, hardly operations relate the splash of lead struck the eye of the volunteer who It penetrated the proximity of such an organ as the eye. The heated platinum was recording the shots in the mantelet. point serves well to break down soft cancerous warts, or to eye, and caused its immediate destruction as an organ of carry the line of the cautery in one definite direction. The vision. Three weeks after the accident the patient came under Mr. Lawson’s care at the Ophthalmic Hospital. The eye was effect of the cautery in improving the aspect of the sore, and then a lost one ; it had no perception of light, and was very in inducing rapid contraction, is remarkable. painful. There were strong reasons for believing that the spray of lead from the bullet was lodged within the globe; and KING’S COLLEGE HOSPITAL. sound eye showed symptoms of sympathising with the lost Under these circumstances Mr. Lawson excised the DISEASE OF THE RIGHT ANKLE OF SIX YEARS’ DURATION ; one. REMOVAL OF THE FOOT BY PIROGOFF’S OPERATION. globe; and he then found that, as had been anticipated, the foreign body was buried within it. (Under the care of Mr. JOHN WOOD.) Chas. B-, aged twenty, one of the 3rd DorsetVolunteers. THE surgical affections of the ankle-joint and tarsal bones On the 28th of June last he was engaged marking at the butts, when a bullet struck the target, and a splash flew off and hit demand at the present day very careful and attentive study his right eye. The firing was at 150 yards. The way in which from the conservative surgeon. Amputation at the upper or the accident occurred was very remarkable. The man was lower part of the leg is not often resorted to ; and the sitting in the mantelet, watching and marking the bullets operator has to decide upon the comparative merits of Syme’s as they struck the target, and after each shot he erased the bullet-mark on the target with a brush, by thrusting his hand and Pirogoff’s amputations, or endeavours to save the foot by the diseased parts. The following case is an inthrough a small slit-window, protected by an india-rubber excising only one in many respects; and an examination of the teresting which closed over the when the hand was withflap, opening drawn. In this case the india-rubber flap which covered the foot after removal proved convincingly that no partial operawould have been beneficial to the patient. slit-shaped window was defective, and when the hand was tion The patient was a Lincolnshire country labourer, twentyit did not fall back its He had to withdrawn, place. just years of age. Six years before he received a blow upon wiped out the last bullet-mark, when another bullet struck five the target; a splash from it flew off, and entered the mantelet the right foot ; and since then the ankle has been affected with and repeated attacks of inflammation. As his through the unclosed slit-window, and struck the cornea of his pain, swelling, general health was failing, the man was sent up to London and right eye, which it apparently penetrated. On July 18th the patient was admitted into the Ophthalmic admitted into King’s College Hospital, under the care of Mr. Upon admission, the ankle was found extensively disHospital. There was a large rent in the cornea, through which Wood. There was no perception eased, although the front part of the foot was quite sound. a portion of the iris had prolapsed. T 2. The left eye Over each malleolus there was a large circular swelling, soft of light. The tension of the globe was and covered by diseased skin of a dark-blue (the uninjured one) was slightly irritable. For all visual pur- and fluctuating, and perforated by several orifices, from which there colour, it was and there was was the lost; painful, poses injured eye A probe introwas a continual discharge of thin sanious pus. reason to believe that there was a foreign body within the duced into one of these openings could be passed through the globe. Mr. Lawson therefore excised the eye. On making a section of it afterwards, he found that the ankle-joint from one side to the other. No rough or carious bone could be detected. The parts were very tender, and spray of metal had passed through the eye, and lodged itself in ’, the sclerotic coat close to the entrance of the optic nerve, and passive movements of the foot gave the man great pain. The that the retina was detached, from haemorrhage having taken integument covering the heel was quite healthy, and there were no signs of disease affecting the posterior part of the os calcis. place between it and the choroid. On June 15th Mr. Wood removed the foot, performing PiroThe man recovered without a bad symptom, and left the goff’s amputation, with the modification first suggested by on July 23rd, relieved of all his sufferings, and with Dr. Eben. hospital Watson of Glasgow, which consists in making an the left eye safe from sympathetic irritation. incision with a bistoury across the sole of the foot from the tip of the one malleolus to that of the other, and then sawing ST. BARTHOLOMEW’S HOSPITAL. through the os calcis from below upwards. The posterior flap is thus formed first, and is turned back before the operator CANCEROUS ULCERATION OF THE FACE TREATED BY proceeds to make the incision across the front of the joint (see THE GAS CAUTERY. THE LANCET, 1859, vol. i., p. 577). The articular cartilages the care of Mr. COOTE.) (Under of the astragalus and bones of the leg were quite healthy, but A DESCRIPTION of the gas cautery, which was employed inL there was very extensive disease of the soft parts, the ligathe following case, will be found in THE LANCET of July 20th. ments were almost entirely destroyed, and the tendons, soft

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