697LONDON HOSPITAL SURGERY.

CONNELLAN were also wounded early, the former twice. Mr.

WYLIE writes:—" I took to a pagoda, dressed Lieutenant

" SwANSTON, and also CONNELLAN, and some others; but Idid not remain long, finding it absolutely necessary to

render to the two remaining officers all the assistance

in - my power in another way " -viz., by encouraging themen to perseverance in duty, and by frequently leadingthem to the charge. This is the truth, modestly concealedin the language of Mr. WYLIE. In one of these charges,he says:" Assistant-surgeon WINGATE, Second Battalion;" First Regiment, attempted to follow me, but was unfortu-" nately wounded. He returned to the pagoda, and the Arabs« very soon surrounded it, and entered, poor WINGATE being91 cruelly put to death by them. SWANSTON and CoNNELLAN" were stripped to their shirts and trowsers. Luckily, a charge" was made just at the time, which drove the Arabs from the" building, and saved our friends." This charge was led byMr. WYLIE ! The Paishwah was accompanied by severalpowerful chiefs, and to encourage their troops, 40,000 rupeeswere offered to any man who should bring in the colours of’the-,First Battalion Native Infantry, and 20,000 rupees for theguns. The presence of the Prince and chiefs, together withthe prospect of reward, incited the enemy, but especially theArabs, to the most desperate exertions. The night, whichbrought water and rest to the wearied soldier, previouslyfrantic from want of water, called Mr. WYLIE to renewedexertions:—" I went to work with the wounded, about 200," including followers." Of the European force engaged on thismemorable occasion, 71’42 per cent. were killed and wounded,while 28.31 per cent. of the Native Sepoys were killed andwounded. These- simple figures illustrate more forcibly thanany description the desperate character of the contest.In Division General Orders, by Brigadier-General LIONEL

SMITH, C.B., it is stated, that " the exertions which the.

European officers had been called upon to make, on leading"their men to frequent charges with the bayonet, had"diminished their numbers : Lieutenant CHISHOLM, of the"Artillery, and Mr. Assistant-Surgeon WINGATE, were killed;"and Lieutenants SWANSTON, PATTERSON, and CONNELLAN were--‘" wounded,-leaving only Captain STAUNTON, Lieut. JoNES, and"Assistant-Surgeon WYLIE, nearly exhausted, to direct the"efforts of the remaining part of the detachment. The" medical officers also led on the Sepoys to charges with the"-bayonet, the nature of the contest not admitting of their" attending to their professional duties; and in such a struggle‘the presence of every European was of the utmost conse-

"quence, and seemed to inspire the native soldiery with their"usual- confidence of success." The conduct of this heroic

detachment, " exhausted by previous fatigue, tormented withthirst and hunger, and cut off from the hope of assistance,"while sustaining, " for a whole day, the unremitting attack ofthe Paishwah’s army," until at length it drove the assailantsfrom the field, with a loss greatly exceeding its own numbers,"it were vain to eulogize.While a monument was erected, at the public cost, to com-

memorate the heroic conduct of those who fell at Corrygaum,inscribed with the names of all engaged in the conflict, thewidows and children of the fallen were provided for. The

two battalions of the 1st Regiment were formed into the"Grenadier Regiment," and Corrygaum, the scene of the

recent exploit, inscribei on the colours. The native portion

of the corps had the benefit of five years’ service granted tothem. Captain STAUNTON was made Aide-dc-Camp to the

Governor-General, Commandant of Ahmednuggur; a sword,with a suitable inscription, was presented to him by the Courtof Directors; while the Prince Regent conferred on him thehonour of Companion of the Bath. Thus far everything waswell done; and we cannot but believe that recompences-"the food which nourishes the military virtues"-were in duetime bestowed on Lieuts. CONNELLAN, JONES, and SWANSTON.But it will be asked by the members of the medical profes-sion-" What recompences fell to the share of the brave Mr.

WYLIE ? What reward was bestowed for his heroic and most-

effective services ? He has been promoted by seniority, anddrawn the pay of his rank, in common with every medicalofficer in India; and that is all!!!To the honour of the Indian medical department, be it

further recorded, that after the battle, Assistant-Surgeon WALLACE, though senior officer to Mr. WYLIE, volunteered toact under his orders. " He waived his claims, and not only"solicited that I might be permitted to retain the charge and" the emoluments, but continued giving me the. benefit of his"valuable aid." In the month, following, "Surgeon CRAWacted a similar part) which, in my humble judgment, refWctson them great honour."

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.WESTMINSTER HOSPITAL.

Aneurism.—Mr. Philipps has now under his care a patientaffected with aneurism, whose case is exciting the liveliestinterest. The progress of the disease has been- very unusualand various points are so obscure, that-they are well calculatedto exercise the discrimination and diagnostic powers of thesurgeon. The poor man is a groom, of about twenty-five, andwas- admitted last July with a pulsatory tumour in the leftgroin, then of the size of a turkey’s egg; the swelling wasclearly aneurismal, and situated close upon Poupart’s ligament.On being questioned, the patient stated that he had not ex-perienced much inconvenience from it-indeed, he had not 0))...served any fulness in the groin until a few days before,although he had had pains in the limb, which he, however,considered of a rheumatic nature. The circulation is hurried,and the heart’s action of an irritable description. It was re-solved to try Valsalva’s plan. The patient was bled to eightounces, and as the pain in the limb was severe, and the circu-lation irritable and hurried, the bleeding was repeated everythree or four days for five weeks. Low-diet and the use ofbut a small amount of fluid were enjoined. During this period,when the patient had been about a fortnight in the hospitalhe complained of uneasiness at the middle of the right thigh,towards the inner side; and on the hand being applied, thepulsations were found diminished along the course of Hunter’scanal. The tumour in the left groin now became painful, andsuddenly increased to double its former size. The interestingquestion now arose, whether any bursting of the sac had takenplace; it was, however, hard to determine the exact nature ofthis sudden change. During the careful examination of thepatient which then took place, and which this unusual occur-rence rendered necessary, it was found, in following the courseof the abdominal aorta, that a suspicion might be entertainedof a tumour situated on that important vessel. It was nowevident that low diet and bleeding were failing in effectingthe coagulation of the blood in the sac, and Mr. Philippsallowed gradually an improved diet, and sufficient doses ofDover’s powder were administered, to relieve the pain in theknee and foot of the left side. Matters went on without muchalteration to the end of October, when Mr. Philipps ascertained,by a careful examination of the inguinal tumour, that all pulsar-

698

tion had ceased in it, nor could the artery be felt beating eitherat the knee or at the ankle. From that time this tumour hasbeen lessening in size. What had taken place here ? It couldhardly be anything but the obliteration of the sac, and theartery connected with it by a firm clot; and if this had reallytaken place, was it not strange that an improved diet and thegiving up of the bleedings had affected what Valsalva’s planhad failed to bring about ? We refrain, however, from givingany opinion, and are content to state the facts, which are, in-deed, sufficiently interesting of themselves. Things were notin so favourable a state in the right thigh; here the tumourwas now very carefully examined; the signs of circulation init were very distinct, and the sac had now reached the size ofan infant’s head. The patient does not seem to be experiencingany particular distress, his sufferings are confined to occa-

sional pains in the limb. It is evident that the depletion,which was enforced for so long a period, did not arrest thegrowth of the inguinal tumour, nor relieve pain; and it wasnoticed that ten days after improved diet had been ordered,and opium administered, the changes became perceptible.The possible complication within the abdomen does not holdout any encouragement to active interference; pressure, which,according to late accounts, has rendered such service in Ire-land, was of course originally out of the question. We shallfollow the further progress of this case with the liveliest in-terest.

GUY’S HOSPITAL.Tumour.--An interesting class of tumours are those which

grow on or about the parotid gland. We last week recordedthe removal of one by Mr. Fergusson, at King’s College Hos-pital ; we have since witnessed an operation of a similar kind,in the above-named region, performed by Mr. Cock, at thishospital. The latter gentleman’s case differs, however,from Mr. Fergusson’s, inasmuch as the tumour was con-

siderably smaller, contained in a proper capsule, and had notcaused the absorption of the parotid gland. We are indebtedto Mr. Madge, the patient’s dresser, for the details of the case.The tumour had been growing five years upon a woman agedthirty-eight, who had been married twice, had had severalchildren, and enjoyed very good health. To the time of ad-mission, (Nov. 28,) the pain had been but slight, and the pro-gress very gradual; it was now found to occupy the whole ofthe parotidian space commencing a little above the tragus ofthe ear, and extending considerably below the angle of thelower jaw; it felt quite soft, but an exploring needle producedbut the oozing of blood. The patient’s history and cheerful,healthy appearance, together with the non-enlargement ofglands, favoured the opinion that the tumour was non-malig-nant. Mr. Cock, on the 17th inst., made a vertical incision fromthe upper to the lower edge of the swelling, about two inches anda half in length; he then carried another horizontally backwards,for about an inch, commencing at the middle of the former, thus,

The flaps were dissected back, when the tumour was ex-posed, contained in a distinct capsule; it was then carefullydissected away from the integuments, without destroying theintegrity of the capsule and the deep-seated parts, great carebeing required to avoid the branches of the portio dura andthose of the carotid artery, transverse facial, &c. &c. The pul-sations of the former could be seen in the parotid gland, andthe lower portion of the masseter was likewise exposed; thedissection had been so carefully conducted as to require butthe ligature of three arteries. The patient, who had beenplaced under the influence of chloroform, has done very wellsince, and is likely to make a good recovery. Mr. Birkett ex-amined the tumour, which weighed four ounces, under themicroscope, and considered it as a low form of fibrous tumour,and altogether wanting the microscopic appearances of malig-nant growths. These cases evidently point to the advantagesof early extirpation; by growing larger, the parotid gland getscompressed and absorbed, and they will sometimes assume amalignancy which they had not at first.Neerosis.-We lately saw Mr. Cock remove a portion of

necrosed tibia, in a case which exemplified, in a very strikingmanner, the effects of repeated slight injuries on a thinly-covered bone. Mr. Madge informed us that the subject, arather strumous lad of nineteen, had been frequently kickedon the right leg by cows, in his occupation of milkman. Noparticular uneasiness was experienced at the time, but slightswelling or discoloration. Three years ago, however, a largeabscess formed, which, on being opened, discharged a greatquantity of pus. The aperture never completely closed; anda twelvemonth afterwards, as the bone was clearly implicated,large incisions were made in the upper and lower thirds of thetibia. The lower yielded some necrosed portions of bone, both

after the incision and subsequently; from the upper, nothingwas obtained but a free discharge of pus. The general health);remained unaffected. The lower wound closed rapidly, andhas left a large and firm cicatrix; the upper has continued todischarge matter, varying in appearance, to the present time.On admission, the leg appeared pretty sound, except in themiddle third, where, in the midst of a large cicatrix, was founda small ulcer, which for a long time had been the only outletfor the accumulation of matter. On introducing the probe, itwas found to pass by the side of the bone to its posterior sur-face, which appeared to be the seat of necrosis. Mr. Cockmade an incision, about two inches long, over the seat of themischief and along the inner edge of the tibia. It was foundnecessary to remove a portion of the healthy subcutaneousbone, to get at the posterior part. When this was effected, aportion of necrosed bone, about three inches in length, wasdiscovered, firmly attached to the surrounding parts, particu·larly to a layer of new bone lying behind it. The careful useof the elevator and other instruments enabled Mr. Cock toremove it without damaging the healthy parts. Several small,irregular portions of bone were afterwards removed. Thehasmorrhage was inconsiderable, and the patient has sinceprogressed favourably. There is a free discharge from ahealthy, granulating surface, which seems likely to fill up the-wound. The general health has throughout been good. Whenthe necrosed portions of bone lie posteriorly, the operationentails no small amount of patience and skill; nor is discrimi--nation less necessary, for determining when to step in and aidand assist nature in the separating process.

LONDON HOSPITAL.

Compound Comminuted Fracture.—Efforts of the most praise-worthy description are in our days made in hospitals, whensevere injury to limbs occur, to remove the latter only whenno other course, compatible with the safety of the patient, isleft for choice. We have witnessed several instances of thiscourse of practice, and will give a brief outline of a case nowunder the care of Mr. Curling, as a good illustration. We areindebted to Mr. Bell, the dresser, for the details of the sameo-On the 30th of October, a boy, eleven years of age,was admitted,_with a compoundfracture of tibia and fibula, caused by his jump-ing out of a window, fifteen feet above the ground, driven tothis resource by the threats of a drunken father. There was,a wound about three inches above the ankle-joint, directlyacross the tibia, through which the fractured bone was pro-truding for about a quarter of an inch; the fracture was:transverse, and on moving the limb, was found to involve thefibula, and to be of a very comminuted nature. The haemor-rhage was so alarming, that the night porter hastily sum-moned the dressers; the latter found the wound bleeding pro-fusely ; careful pressure was applied; the limb settled on theside splint; the child put to bed, and a dose of opium ad-ministered. The next day, Mr. Curling approved of the meansadopted, and coufirmed the diagnosis. Reaction was very con--siderable,and the usual remedieswere ordered; but, towards the-middle of October, three large abscesses formed along the course-of the tibia; these were opened, and discharged a large quantityof pus. The child’s health began now to suffer; he had quickpulse, flushed countenance, brown tongue, &c. The questionwas now debated, whether the limb should be taken off to save-life ; but this extreme course was deferred, from the healthyaspect of the wound, and from the fact, that the abscesseswere extending so high, that amputation of the thigh musthave been performed. These are very painful alternatives.The boy, however, was given stimulants and tonics, and putupon full diet. Pressure to the sinuses was applied, and thelimb was slung on the apparatus used in this hospital, (which’we shall soon revert to, and give a detailed description of.)Matters soon took a better turn: the sinuses, which extendedhigh towards the knee, gradually closed; others, where pro-bably dead bone lay, are slower in their progress; but the pa-tient’s health, by this judicious treatment, has much improved.He has resisted the weakening effects of extensive suppuration,and is now likely to do well.

ST. BARTHOLOMEW’S HOSPITAL.

Malignant Tumour.—Persons witnessing a. surgical opera-tion, and observing the operator’s coolness, his seeming indif-

, ference as to the pain or loss he inflicts, his reeking hands,.; and steadiness of purpose, would hardly imagine the amount

of humanity, kindness, and consideration for human suffering,, which are hidden under these stern appearances. We were

forcibly reminded of this fact when we heard, last Saturday,;Mr. Stanley explain to a patient, who had applied to him for

699

removal of a malignant growth of the jaw, his reasons for de-clining to interfere in the case. It s no easy task for a manof right feeling to tell a fellow-creature that he must sinkunder the affection for which he is seeking relief; and thehumane and adroit manner in which Mr. Stanley conveyedthe unwelcome intelligence, made a deep impression upon us.The patient is a cooper, forty years of age, apparently enjoyingpretty good health, who was admitted into Darker ward onthe 5th of December, under the care of Mr. Stanley. Onthe left side of his face a swelling is situated which formsa projection originating in the lower jaw. The size isnot considerable, though very obvious, and the tumourhas been growing for the last five months only. Onopening the patient’s mouth, the first thing which strikes theobserver is the blackness of all the teeth, and the abnormalgrowth is then perceived to involve a great portion of themouth. It is of the nature called by Mr. Stanley epithelialcancer, and has evidently sprung from the mucous membrane,which is now in this locality transformed into a fungousgrowth. The disease is extending backwards to the softpalate, largely implicates the cheek, and seems even to reachdown the pharynx. The left side of the mouth is much en-croached upon by this fungous mass, which likewise blocksup its posterior part. Mr. Stanley thinks that this tumoursprings from both sides of the jaw, and (as he peculiarly ex-presses it) is attached to the inner and outer gum. There isnot much pain complained of, but deglutition is somewhatdifficult. The patient attributes this growth to having caughtcold whilst under the influence of mercury, and it is likewisethis metal he accuses for the dark colour of his teeth. Nocancerous disease has existed in his family, and he mentionsthat he has been salivated three different times, which happenedabout seven years ago. Mr. Stanley having consulted his col-leagues, came to the resolution to decline removing the tumour.Mr. Stanley considers that the disease extends much too farbackto hold out any chance of benefit, even by amputating half of ithe lower maxilla; the disease springs from either side of thisbone, and though the abnormal mass were shaved off, or thealveoli removed, as was first suggested, there would inevitablybe a return of cancerous growth. The glands in the sub-maxillary region are enlarged, and this is an additionalcounter-indication. The malignant nature of the disease couldhardly be doubted, and it answered pretty well the followingdescription, in Mr. Stanley’s " Treatise on the Bones," p. 262:"Notwithstanding the slow progress of epithelial cancer, itpresents malignant features, in its tendency to invade the ad-jacent soft tissues, and its contamination of the adjacentabnormal glands." Mr. Stanley laid before his patient,with impressive kindness, that he did not feel justified in in-terfering, and made him understand that insensibility couldnot be kept up sufficiently long, that the least particle ofdisease left behind would certainly cause a return of it; thatno operation could be undertaken without a certain amount ofprobability of success, and that life might be endangered byit; besides the chance of the disease returning sometime after-ward. He held out the hope that by care, and regular living inthe country, such growths may sometimes remain btationary.

Medical Societies.

WESTMINSTER MEDICAL SOCIETY.

SATURDAY, DECEMBER 15, 1849.—MR. HIRD, PRESIDENT.

Six fellows were elected and two proposed.INSANITY FROM THE USE OF CHLOROFORM DURING PARTURITION.

Dr. WEBSTER related the following case, communicated tohim by a professional friend, in consequence of perusing inTHE LANCET a report of the three similar instances he hadmentioned at a previous meeting of the Society. Only onedrachm of chloroform, sprinkled upon a handkerchief, wasused; but the it produced was so sudden and violent,that the patient, after inhaling, remained quite insensible,which greatly alarmed the attendants. With the insensibilitythere was likewise deadly paleness of the countenance; how-ever,she slowly rallied,but had a painful and protracted labour.During several days subsequently, the lady continued in a verynervous condition, although not then actually incoherent, butshe soon became so furiously maniacal as to require coercionby a strait-waistcoat. After being insane during many months,the patient gradually recovered her reason, and ultimately gotconvalescent. Considering it was only from accumulated facts

and extensive experience that sound practical knowledge re-specting the employment of chloroform in midwifery could baacquired, Dr. Webster then said he had related the presentas likewise the previous examples of insanity following its use,in order to contribute data towards that important object; andhe availed himself of the present opportunity to state, that heshould esteem it a favour if other practitioners would com--municate to him any well-marked cases of the same kind,.with particulars, which they may have met with during theirpractice, as he (Dr. Webster) was very desirous of collectingadditional evidence upon this interesting subject, of course,on the express understanding that neither the patient’s nameshould be divulged nor the correspondent in any way compro-mised, all such communications being considered strictly con--fidential in regard to individuals. -

Some conversation followed, chiefly with reference to thecase being incomplete.

FATTY DEGENERATION OF THE CORNEA.

Mr. CANTON displayed some sections of the cornea, underthe microscope, taken from a female aged eighty-two years,with a view of showing the arcus senilis to be a fatty degene--ration of the cornea, the particulars of which were publishedat p. 683 of THE LANCET of last week.

TWO HEN-EGGS, UNITED AT ONE END BY A NARROW NECK.

Dr. CORBIACI exhibited two hen-eggs, united at one end bya narrow neck. The eggs were somewhat misshapen, by havingbeen pressed on each other. Dr. Cormack believed the spe-cimen to be unique. Eggs with double yelks were not un-common ; and he had once seen a triple yelk; but here weretwo eggs in distinct and perfect shells, joined by a neck also,thinly covered with shell. It was surprising that the henhad been able to pass the united eggs, from the breadth andparallel position, because hens often die when the egg is in a.

transverse position, if those in charge do not introduce a fingerand turn the egg. The hen was five-toed, of the Dorkingbreed, and belonged to Dr. Cormack.

UTERINE SCARIFICATORS.

Dr. RouTH exhibited to the Society three uterine scarifi-cators, made by Mr. Coxeter, of Grafton-street. Two of these,he remarked, were of little practical utility. Of the third, hebelieved he was the inventor, though it was founded uponthe principle of other instruments used abroad. It was to’this instrument he wished, therefore, to call the attention ofthe Society. It consisted of an external metallic case or tube,one end of which was dilated, to receive four lancets, concen-tricallv arranged. The lancets were fastened upon a steelrod, which passed through the tube to the opposite side, con--nected within the case with a spiral spring, the effect of whichwas to keep the lancets, when in a state of rest, within thedilated part of the tube. The end of the steel rod projectingon the opposite side was terminated by a circular disc, betweenwhich and the tube was another little steel disc, playing on ascrew, by which the projection of the lancets might be gra--duated. The difficulty was in keeping the lancets clean. This,.however, was greatly facilitated by a peculiar arrangement inthe central rod, which was so made as to unscrew in two parts,about two-thirds down the tube; and in this manner the upperportion could be drawn out and cleaned; while in like mannerthe tube, by the passing of a piece of lint within it, could be-wiped. The quantity of blood, however, that penetrated downthe tube was very trifling. In the application of the instru-ment, a speculum was first used, to bring the os and cervix inview; and the instrument, being passed up through the spe-culum, was thus brought in contact with the uterus. Theslightest pressure now upwards of the disc caused the lancetsto penetrate into the substance of the cervix; whiie the spring,on the removal of this pressure, caused the lancets to returninto the dilated tube; and in this manner, by the alternatemovement, the cervix uteri could be punctured ad libitU1n,and to any depth. Now congestion of the os, with all its dis-agreeable consequences, and prolonged cervix, causing vaginalirritation, metritis, &c., were very common affections. Inthese cases, lie (Dr. Routh) was in the habit of first punc-turing freely the cervix; but in prolonged cervix, where morehaemorrhage and absorption of substance was required, in ad-dition to the puncturing the cervix, by turning the disc fromleft to right, h** was enabled to cut it up in little portions.Then, by applying a solution of nitrate of silver, (from twentygrains to one drachm to the ounce,) much haemorrhageand great absorptive action was set up in the part, and thedisease removed effectually. The use of leeches in the ordi-nary way, or caustic, were both tedious processes, and usually