became more severe, and extended to the lower extremity of that side. He applied to various hospitals and public charities, during the next two years, and the disease was always pronounced to be SCIATICA, and treated (unsuccessfully) as such. Leeches and blisters innumerable had been applied, without effect, and at length he took up his final residence in the HôTEL DIEU, in March, 1828. Then, as during the preceding five years, he complained only of excruciating pain, stretching from the left lumbar region, down along the lower extremity of that side. After an examination into the history and symptoms of the case, the disease was once more pronounced to be SCIATICA, and treated accordingly. All the organs appeared to be performing their functions regularly, except the bowels, which were so constipated that the patient had only one evacuation every twelve or fifteen days. This circumstance induced the medical attendants to institute a more rigorous examination, and the result was the discovery of an oval tumour just below the umbilicus, about the size of a man's fist. It presented distinct pulsations synchronous with the arteries. The diagnosis was now altered from sciATICA to aneurism of the lower portion of the aorta, or of the left primitive iliac. This explained (so they thought) the pain in the course of the sciatic nerve, and the cedema of the limb. They did not employ the stethoscope in this examination, and the infiltration was too great to permit the crural artery to be felt, so as to ascertain the state of the circulation below the aneurismal tumour. The patient was too much reduced to admit of depletion, and an analeptic regimen merely, with opiates, were all that could be employed. He at length sunk exhausted by the excruciating and incessant pain.

Dissection. Before the abdomen was opened, they again examined by external manipulation, and again the aneurismal tumour was felt as distinctly as in the living body-with the exception of pulsation. The parieties were then incised, and, to the astonishment of all present, the aneurism was converted into a contracted bladder, whose coats were thickened, and whose situation was changed in consequence of a cancerous tumour in the pelvis, which seems to have sprung from VOL. X. No. 19.

the left ilium, displaced and jammed the rectum, and nearly filled the cavity of the pelvis. The bladder, in fact, was pushed up out of the pelvis, and rested on the left iliac artery, from which it derived its pulsatory movements. The mass of disorganization, involving bone, muscle, nerve, blood-vessels, &c. could not be unravelled; but when the ilium was cleared by masceration, it was found to be more than two inches in thickness, and its texture resembled that of a sponge with very fine areolæ.

We think there is little doubt that the stethoscope would have proved the nonaneurismal nature of the tumour, and saved the ridiculous diagnosis that was given. It is true, the error did no harm in the above case; but had the patient lived on this side of the channel, the celebrated operation of ligature" ultra tumorem," would certainly have been performed. After such an operation, it is probable that the aneurism would not enlarge, and the triumph of surgery would be complete. If death and dissection revealed any unpleasant phenomena, the whole would, of course, be candidly recorded in the pages of some periodical.

11.

GUY'S HOSPITAL.

I. INJECTION OF THE CAVITY OF A PSOAS ABSCESS.

The province of surgery appears to be undergoing a total revolution in the BoROUGH. Some little time ago, they hit upon the plan of curing scirrhus of the testis by tying, or excising its excretory duct, and now they are treating psoas abscess by injection! Time was when the surgeon was constantly in dread of admitting even air into the cavity of this abscess-when each had his plan of preventing the ill effects, believed, or supposed to follow its mere opening. Mr. Abernethy carefully squeezed out the contents, and instantly closed the puncture by adhesive plaster, whilst others abstained from employing the least pressure, but contented themselves with allowing the contents to drain in a poultice. These various precautions, these obvious fears, argue the existence of some degree of

danger, real or imaginary, and lead us to regard with feelings of surprise, we might almost say, dismay, the practice pursued in the following case.

John Cogle, a scrofulous young man, was admitted into Guy's Hospital, on the 21st of May, and placed under the care of Mr Key.

On the inside of the thigh was a tumour of considerable size, dilatable on coughing, the integuments over which were thin, at one part red and inflamed. The patient was pale, emaciated, and hectic; the bowels were regular; the appetite bad: the constitutional irritation and disturbance considerable. The disease would appear to have originated in a strain received in the back more than a year before admission; the tumour in the groin was of ten or eleven months' standing. He was put on a generous diet, and or dered a grain of the sulphate of quinine, eight drops of dilute sulphuric acid, and two ounces of infusion of roses, twice daily. Wine and porter were likewise allowed. In the early part of June, the abscess had nearly closed, its walls were thin and flaccid, and the pus which it contained was diminished in quantity. The bowels were costive, the general symptoms but little relieved.

"Mr. Key wished that what pus was left in the cyst should be evacuated, and that a lotion, composed of two grains of the sulphate of zinc to two ounces of water, should be injected once a day into the cyst. The limb to be bandaged with a roller carried up to the groin, in order to produce, if possible, cohesion of the sides of the cavity. The patient was ordered to take two grains of the sulphate of quinine, half a drachm of the sulphate of magnesia, 30 drops of tincture of henbane, and one ounce of water, twice daily." As a natural consequence, this injecting produced an accession of fever, and was necessarily discontinued, whilst, to calm the excitement, effervescing mixtures were required. On the 26th of June, the sides of the abscess had in great measure cobered, and the patient appeared to be better. The injection was a second time tried, and appeared to produce no obvious ill effect. However, he emaciated even more rapidly than ever, and, early in July, a fluctuating tumour made its appearance in the loins, on the opposite side. The hectic was now severe, and on opening

this abscess a pint and a balf of matter was discharged. A piece of lint was inserted in the opening to prevent its elosing, and a linseed poultice applied! The patient lingered on till the 4th of September, when he sank. No inspection of the body was allowed by the friends.

We really hope, for the sake of the surgeon, that the above report may be found to be inaccurate, for of all the modes of treating psoas abscess which ever we heard of, this appears the most extraordinary. We never saw a case of the disease, where it was not connected with disease of the bones or intervertebral substance of the spine, whilst the swelling which appeared in the opposite loin proves to demonstration, that such complication obtained in the present instance. Knowing that this is almost always the case, that the abscess may be called constitutional, generally occurring in, and ever an augur of a bad and a scrofulous habit; bearing in mind that it points in the thigh, but arises in the back, what can we expect from the closure, by art, of its external opening? The sequel of this case is an answer to the question; a larger and more formidable collection of matter in the loins, in consequence of the discharge being denied a ready exit beLow! Another point in the treatment is a matter of curiosity. In the lower abscess, Mr. Key used injection and strapping in order to produce adhesion of the walls, whilst the upper was treated in a manner diametrically opposite, viz. by the introduction of a tent to maintain the opening! This is surely blowing hot and cold!

II. COMPOUND FRACTURE OF THE TIBIA AND FIBULA-DIFFICULTY OF REDUC. TION AMPUTATION.

A stout-looking man, who had abstemiously confined himself to the copious imbibition of porter and ale, received from an apparently trifling injury, a compound fracture of the tibia and fibula, the wound being small, and the bone not protruding. The reduction was accomplished with considerable difficulty; the limb then bound up for some inches above and below the fracture with alternate straps of adhesive plaster; a splint applied on each

side from the ankle to knee; the patient laid supine; and "the leg placed on the bed in a fracture-box, of such a height, that the leg alone was raised about eight inches from the bed; both thigh and leg being consequently semiflexed;" a description which we cannot at all comprehend, unless it is figuratives of a double inclined plane. This was on the 5th July, and on the evening of the 7th, re-action having taken place, the limb was become hot and painful, and swelling had come upon the ankle and lower part of the leg. Several of the straps were cut through with relief-pulse 110, full and strongtongue white and coated-bowels confined. Three grains of the submariate, and six of the compound extract of colocynth were directed to be taken, but although the limb was less painful on the 7th, a number of vesicles had appeared around the fracture, and the pulse was rather smaller and quicker.

On the 8th, the limb was exceedingly painful, the tongue less furred, pulse 100, and jerky. The straps were now removed, but a roller remained above and below. The bones were as yet in apposition, the wound appeared sloughy, and next day presented a slough an inch square. The integuments around were dark-coloured, and covered with bullæ, the discharge very fetid and profuse, pulse 120, tongue cleaner. The uppermost bandage was now cut away, and the leg appeared straight. On the 10th, all the symptoms were worse, the limb still more swollen, the skin darker coloured. Calomel and opium at bed time.

The severer symptoms now began to fade, but the bones became displaced, the upper portion of the tibia projecting through the wound. The first apparatus was now removed, powerful extension put in force, apposition obtained, and the limb laid out straight, the heel being raised a few inches. A splint was lightly fastened on each side the limb by means of tapes, and a poultice laid over the wound. On the very next day, the protrusion of the upper part of the tibia reappeared, and continued in spite of every possible change of position. A part of the tibia was even sawed off without effect, which obliged Mr. Key, to resort to amputation after all. On dissecting the

limb it was found that the tibia was fractured obliquely, whilst a splinter of bone very nearly detached, had transfixed the flexor longus digitorum, proving, thereby, a continual source of irritation to the muscle, and stimulating it constantly to contraction. This contraction, aided by the inflammation, of necessity set up, and preventing the muscle from duly relaxing, inevitably dragged up the lower part of the tibia, and forced the extremity of the upper through the wound.-Gazette.

This is the explanation offered by the reporter, and it may be, nay, probably is, the correct one. We have heard it remarked, by a person well qualified to give an opinion on the subject, that fractures, in general, are not managed well in the hospitals of the Borough. Without giving in to so sweeping a charge, we are "free to confess" that the practice pursued in this particular case, is not altogether to our taste. A full-bodied man, accustomed to the use, we should rather say abuse, of malt liquors, receives a compound fracture of the leg, without the infliction of any great shock on the system at large. The first thing that is done is to strap up the leg, in other words, apply the most unyielding compression to a part which must shortly and inevitably swell. This we do not like. In the next place, reaction is established; the limb is hot and painful, the tongue white and coated, the pulse above a hundred, full and strong. Surely venesection in such a state of things is required; surely the exhibition of a purgative pill is little more than milk and water practice.* We really might remark in a similar tone on several other items in the treatment of this case, but shall merely observe, that a want of activity seems to have pervaded the whole. We hate picking critical holes in the literary coats of other people, but it is a duty from which we dare not shrink, to comment on error whenever we think (it may be erroneously on our own part) that it obtains.

III.

LA CHARITE.

I. MYSTERIOUS EPIDEMIC IN PARIS.

The DANDY FEVER (of which some curious particulars will be found in the present number) has scarcely excited greater interest in the West Indies, than does an unnamed and apparently unnameable epidemic (which has recently made its debut) in Paris. It was first observed in a particular locality, the Infirmary of Maria Theresa, but has since spread to various quarters of the city. Dr. Mequel is employed in drawing up an account of this epidemic; but in the mean time, some interesting particulars have been reported from the wards of M. Cayol, in LA CHARITE. Five patients affected with the disease have been received there, of which one is dead-one has recovered-and three are still confined to their beds. We shall present our readers with some sketches of these cases.

Case I. This was the Infirmary-man of the MARIA THERESA above-mentioned, who entered LA CHARITE on the 5th of July. He is 42 years of age, and is the first person who has had the disease, as far as is yet known. He had previously enjoyed excellent health. On the 4th of June, and without any appreciable cause, he was seized with general malaise, followed by shiverings, vomiting, violent head-ach. The throat became sore, as also the eyes, while the eyelids and the whole face became swelled and edematOus. There was considerable fever and much agitation. Venesection-leeches to the neck and temples-low diet. During ten or twelve days, this state continued, without any amelioration, in despite of antiphlogistic treatment the most active. At this period, the symptoms subsided, and in two or three days, they were nearly gone, when, all at once, the patient was seized with acute pains, which he compared to "traits de feu," in different members, sometimes fixing themselves on the feet, sometimes on the hands, which then became the seat of the most insupportable sensations of formication and pricking"de formication et de picottemens." These new phenomena became daily more alarming-especially in the night, when the patient's torments were terrible,

and the burning heat of his feet allowed him no repose. The medical officers of the Infirmary suspecting some affection of the spinal marrow, bad applied cuppingglasses along the spine, and afterwards blisters, without any relief. He was then carried to LA CHARITE. The poor fellow was, by this time, completely deprived of the use of his limbs, while the sensibility of some of his members was so excessively and morbidly acute, that the slightest touch threw him into convulsions. The pains indeed were not so acute as at the beginning; but they came on in paroxysms with very short intervals. The annoying sense of formication and pricking still continued unabated in the hands and feet. There was now no fever, no head-achthe appetite was very keen.

M. Cayol, (who had been physician to the Infirmary where the patient was first taken ill) still continued to think that the spinal marrow was affected, and ordered moxas to the neigbourhood, but without the least success. The periodicity of the paroxysms next attracting his attention, he prescribed the sulphate of quinine in very large doses, but still without producing the least relief. Opium was then tried, the dose being gradually increased to seven or eight grains a day. No good effects resulted-and on the 23d of August, when the report closed, the patient was in nearly the same state as when he entered the hospital on the 5th July!

Case 2. This was the case which terminated fatally. He had been ill for three months. The patient was a man about 40 years of age, a coal-heaver, inhabiting the "PLACE DE GREVE," a damp and unhealthy situation on the banks of the Seine. His constitution had been much deteriorated by the misery of his life, when he was seized, like the former patient, with shiverings, vomiting, fever, cedematous swelling of the face, &c. His wife and daughter became affected in the same way, and about the same time. They all attributed their illness to the dampness and wretchedness of their situation, and continued their avocations for eight or ten days; when acute pains in their limbs-formication and prickings-burning heat in the hands and feet-excessive debility, &c. confined

them to their beds, where they lay upwards of two months, before they determined on claiming the resources of an hospital. The man was carried to LA CHARITE, and, although he did not then present any of the phenomena of fever, yet his general aspect indicated a fatal result. His lower extremities were wasted, and incapable of voluntary motion-their surface covered with furfuracious scales, and of a dark earthy colour-hands in the same state-face no longer oedematous; but his eyes were lachrymose and very painful. A few days after this, the patient's daughter was able to pay her father a visit, and, on this occasion, he became greatly agitated. The next day, fever was kindled up, accompanied by harassing cough, and copious expectoration. The chest sounded well, and the respiration was heard, without "râle ;" but there was deep-seated pain in the thorax, and two small bleedings were employed. The blood was not inflamed; and the thoracic affection was increased rather than diminished. The tartrite of antimony was then employed in large doses-eighteen grains in the 24 hours. There was a momentary mitigation of the pulmonary affection; but the fever increased, and the patient soon died delirious.

Dissection. The lower portions of the lungs were gorged with a black and fetid serosity; but otherwise crepitous, and permeable by the air Heart flaccid and

soft. The liver presented a remarkable appearance, being, as it were, crisped up, or shrivelled. The spleen was enlarged to double its natural size. The most accurate examination did not detect any organic lesion in any of the viscera of the head, spine, or abdomen.

Case 3. This was the patient cured. The symptoms were the same in kind, but slighter in degree. His wife was affected with the same complaint, but they both recovered.

Cases 4 and 5. These are both females. They have been ill more than two months, with this strange complaint. The second

plaint, which commenced in the way already described. To the usual symptoms was added a most obstinate and constant cough, without any pain in the chest. In the course of a few days, this catarrh took on a new character. The cough became periodical, occurring in violent paroxysms, several times in the day, and was then in. describably distressing. The patient felt as if all the bones of the thorax were breaking; while the extremities were contracted, convulsed, and the seat of a burning pain. These paroxysms were always preceded by a chill or rigor, which some. times lasted three quarters of an hour, terminating in vomiting. In the intervals, the patient felt overwhelmed with weakness, and complained of a sense of formication and pricking in the hands and feet. These symptoms continued for about three weeks, and then became gradually mitigated. The skin is quite black on the chest and abdomen-the face swelled and œdematous-the eyes lachrymose. Latterly the patient has been free from the paroxysms of cough; but every morning she had a cold chill, which ushered in some febrile movement of an aguish character. Before she entered LA CHARITE, she took no medicines. Since then, she had an emetic, and afterwards opium and quinine. After taking the bark, for a short time, sleep returned, the febrile accessions are scarcely perceptible-the cough is gone-and, in fact, she is nearly well.

The foregoing epidemic, we think, will puzzle our systematic nosologists! We know of no other probable etiology than that which we are certain Dr. Macculloch would give-a MALARIA. The intermittent character which it has decidedly assumed in some of the cases at least-and the neuralgic character manifested in all of them, render it highly probable that the disease is of malarious origin--and of the neuralgic order.

IV.

HOSPITAL OF SURGERY.

which are more remarkable than in the other. The patient is 29 years of age, and entered the hospital on the 14th of August, being then six weeks ill of the com

ED INTO ADIpocere.

In the month of October, 1827, the following short notice of a "case of enor