134

retically and practically, tending all the more certainly andquickly to cause death-

1st. By increasing the congestion of the lungs;2nd. By arresting lung action in more ways than one, to be

hereafter detailed; and C,

3rd. By circulating poisonous blood in the system.In these results I am remarkably confirmed by Dr. Waters,

of Liverpool, in his "Researches on Aspbxia"-a paper readbefore the Royal Medical and Chirurgical Society subsequentlyto the appearance in THE LANCET of the first portion of thisarticle. And these conclusions, of which I hope shortly toshow still further proof, are all in accordance with the viewsof the nature of drowning held by the ablest writers on thesubject.The hot bath, as the Royal Humane Society have used it of

late years, for the treatment of drowning, is, then, an error,and a serious one.

(To be continued.)

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

UNIVERSITY COLLEGE HOSPITAL.

KELOID OCCURRING IN THE CICATRIX OF A BURN;EXTIRPATION; RECOVERY.

(Under the care of Mr. ERICHSEN.)

Nulla est aHa pro eerto noscendi via, nisi quam plurimas et morborum etdissectionum historias, tarn aliorrm proprias, collectas habere et inter se con’-parare.-MORGAGNI. De Sed. et Caus. l,[(fI’b., lib. 14. Proremium.

FROM the resemblance in some way which this disease hasto the claws of a crab in the prolongations of the tumour, thename of keloides was given to it by Alibert, after he had aban-doned the term cancroid. On reference to various works onthe skin, we do not find that the origin of keloid in the cicatrixof a burn is mentioned. Dr. Warrcm, in his work "On Tumours," "

objects to the term used by Alibert, because in one kind ofthis affection, which must be referred to this head, there areno such crab-like processes, and they do not always exist inthe others. Under the head of Keloides, Warren places threevarieties:-1. A white permanent elevation of the skin. 2.The spider-like pimple of the face. 3. The keloides of Alibert." The first variety is a rising of the true skin in the form ofthe cicatrix of a burn. It is a white elevation of the skin,without discoloration, or with a very slightly coloured margin,not sensible nor painful; but differing from the cicatrix of aburn in its disposition to grow, and in the difficulty of eradi-cating it. No ulceration occurs, nor does it terminate in amalignant disease- A g ;f rp.qpmhlPR thp Rear of a burn. soit some.times o1Õ;;;t;-i;-;u1; a sca2. It is seen to occur in dis-ordered habits, after operations for the removal of smalltumours, such as common warts, small encysted tumours," &c.

-p. 41. He cites several cases where two or three operationswere required in consequence of a return of the disease in thecicatrix afterwards. It is most probable that the fibro plasticgrowths that have a tendency to spring up on scars, describedby Mr. Hawkins under the name of warty tumours of cica-trices, are either examples of keloid, or sGnngly allied to it.Keloid is most common on the neck, shoulder, and front of thechest, where it spontaneously appears. We have seen two in-stances wherein it sprung up in the neck in the cicatrix of aburn, the patients in each case being comparatively young. Inthe first, it occurred in a boy aged thirteen, under Mr. key’scare, at St. Bartholomew’s Hospital; in the second, in a femaleaged twenty, in University College Hospital, who was sub-mitted to an operation for its removal, under the influenceof chloroform, on the 16th of January last, by Mr. Erichsen.She was burnt many years ago in the neck. This healed afterawhile, and remained free from inconvenience until about ayear ago, when the cicatrix began slowly to enlarge and widen.

It was now a quarter of an inch broad, and several inches long,running across the lower part of the front of the neck. Afterits removal, by carefully dissecting out the entire cicatrix, the, edges were brought together by silver sutures, and so adjustedthat in the healing a mere linear cicatrix should be left. Therewas free bleeding during the operation.

In some remarks afterwards, Mr. Erichsen observed that, inthis instance, there was a warty cicatrix of the neck, some-what linear, elevated, smooth, shining, pinkish-brown, and re-sembling keloid. It occurs, he said, in young women andchildren, about the throat and anterior parts of the neck. Hehad not seen it elsewhere. It is often inconvenient from theintense itching, causing the patient constantly to tear andscratch it. In the present instance there was nothing malig-nant, cancerous, or cancroid developed. It was a fibro-vas-cular growth, quite different from the contractile cicatrixusually resulting from a burn.As every part of the keloidal structure was removed, the -

wound readily healed, with a thin linear cicatrix, and the pa-tient left the hospital recovered. ’

Another case was a boy, aged thirteen, a patient in St. Bar-tholomew’s Hospital, under Mr. Skey’s care, in November,1859, who then presented a good example of keloid in the

cicatrix of a burn. Five years before, he was scalded over theface, ear, and chest, and also at the back of the neck, by theupsetting of a teapot. The scalded parts, which afterwards.became the seat of keloid, were slow in healing, and dischargedmuch offensive matter. The tumour was hard, tough, raised,and irregular at its edges, and extended from the ear along theside of the neck to the upper part of the chest. He was underMr. Gowlland’s care at the Islington Dispensary, and subse-quently under Mr. Curling at the London Hospital. Thelatter gentleman removed two isolated portions from the upperpart of the mass ; the wound healed, but the disease returnedin the same spot.When admitted under Mr. Skey, the tumour had extended

more upon the sternum, but in other respects was in the samestate as it had been for the last three years. In Oct. 1859, Mr.Skey removed the upper part of the tumour, and a fortnightlater a portion lower down. Much haemorrhage occurred onboth occasions. He left the hospital well, but we are notaware whether the disease has recurred.

GUY’S HOSPITAL.

MEDULLARY CANCER OF THE TESTICLE OF REMARKABLY

RAPID GROWTH; AMPUTATION; RECOVERY FROMTHE OPERATION.

(Under the care of Mr. BRYANT.)WHEN medullary cancer appears in the testicle, it is usually

in children or persons in early adult life. We have recordedseveral examples in boys, in whom the disease appeared with-out any assignable cause. At the age of forty and upwards itis very seldom that this form of malignant disease originates’spontaneously; we recently, however, witnessed the followingexample :-A streng, healthy-looking man, a ship’s carpenter by trade,

was admitted into Guy’s Hospital with very considerable en-largement of the left testicle. He had always enjoyed excel-lent health up to four months before his admission, when he.observed some slight swelling of this organ; it began to in-crease in size, and in the course of sixteen weeks it had attainedthe bulk of a newly-born infant’s head. It was now coursedover by large veins, and felt semi solid to the touch, with anindistinct sense of nnctuation in certain parts. 2r. Bryantintroduced a trocar and canula into one part of it, which gaveexit at first to some blood and then to a small quantity of serum.He believed, before resorting to any operation, that it waspossibly sero-cystic disease of the testis.On the 9th of April, 1861, chloroform was given to the

patient. An incision was made over the tumour from abovedownwards, and it was readily freed from the integuments.A ligature was applied around the spermatic cord and vessels,and they were divided. The parts were then brought togetherby sutures, after all venous bleeding (which had been free) hadceased.A section of the tumour showed it to be medullary cancer;

in fact, it was one of the most distinct examples of this disease,and contained patches of effused blood in two or three places

During the operation a small cyst filled with serum was found

135

to be present anteriorly to the tumour, developed, in a small por-tion of the tunica vagimtlis. The cancerous disease seemed tohave involved the entire testicle, but did not extend upwardsto the cord.The pfètient went on very well, and made a good recovery

from the operation. The ultimate prognosis is, however, of avery srave character.

ST. MARY’S HOSPITAL.

SYPHILITIC ABSCESS ENDING IN FISTULA IN ANO.

(Under the care of Mr. COULSON.)THE pathology of fistula in ano is a subject of interest, as to

which some things still remain to be cleared up. The pupilsof Mr. Coulson’s class at St. Mary’s Hospital have had the op-portunity of observing, in the case of a young woman, agedtwenty-two, who has been lately in the hospital, theianuenceof asyphilitic taint in causing the disease. Her history included thefacts that two years since she had contracted primary syphilis,for which she was appropriately treated; recovering; and re-maining well up to the previous month, when she was seizedwith vomiting, a febrile condition, and sore-throat. These

symptoms lasted for about two days, and were succeeded bythe eruption of rose-coloured patches and the occurrence ofpains in the limbs. Under the inpuence of iodide of potassiumand blue-pill these symptoms disappeared. About a weekbefore admission she perceived a swelling in the neighbourhoodof the anus, causing her pain in the sitting posture; and after anight of great suffering she passed purulent matter on going tostool.When admitted, the left nates were swollen, and there was

a tumour to the left of the anus two inches in length. Thebowels acted regularly, but with pain; and there was consider-able tenesmus. These symptoms increased, and after a fewdays, the abscess coming near the skin, Mr. Coulson made anincision, which permitted the escape of fetid pus. Mattercontinued to escape by the bowel and through the cutaneouswound, and subsequent examination determined the existenceof a true fistula of considerable size. This Mr. Coulson di-

vided, after preparatory treatment, and laid the sinus freelyopen. The wound was dressed with oiled lint, and the patientis doing well.

Here the formation of abscess by the side of the rectum(favoured by the syphilitic diathesis), its ulceration into thebowel, subsequent advance to the skin externally, and the for-mation of a true sinuous fistula, were observed in a typicalsequence.

_____________

CHARING-CROSS HOSPITAL.

ACUTE RHEUMATISM RESULTING IN DISORGANIZATION OF

THE LEFT WRIST-JOINT.

(Under the care of Dr. SALTER.)DANIEL S--, aged thirty, single, by occupation a stoker,

was admitted January 3rd, 1860, suffering from rheumaticfever. He had always enjoyed good health up to December7th, when he was attacked with pain and swelling of the wrist-joint of each hand, which left him in t. few days. Three weeks

afterwards (Dec. 28th) he was seized in the night with pain allover him, shivering, and vomiting. He was seen two daysafterwards, when he was suffering frof:1 pa,in and swelling inmost of the joints, complaining especially of the left arm.On admission, he was ordered a mixture of citrate of potass,

sesquicarbonate oi ammonia, tincture of opium, and compoundrhubarb mixture every four hours ; cotton wool to the joints,and a compound soap pill every night.He gradually improved after his admission into the hospital

up to January 9th, when he may have been said, as far as hisgeneral condition went, to be convalescent; but on that day hewas seized with severe pain in the left wrist. In his mixturethe ammonio-citrate of iron was ordered to be substituted forthe rhubarb mixture thrice a day.

Jan. llth.-‘JlTrist no better, in fact worse; pain constant ;joint immovable without the most severe pain; the hand hasbecome cedematous. Ordered a blister, the size of half a crown,to be applied to the back of the left wrist.16th.-No better; the patient feels extremely weak; cedema

increased; hand quite fixed; gets no sleep at night on accountof the pain in the wrist. Ordered compound soap pill every

night, and to have a mixture of tincture of the sesqnichloride ofiron, dilute nitro-muriatic acid, and infusion of quassia ; andalso two drachms of cod liver oil thrice a day.

17th.—Wrist no better. Another blister.24th.-Dr. Salter ffinding that the patient was quite well,

with the exception of the left wrist-joint, that his rheumaticcondition had entirely passed away, the man eating and drink-ing and walking about the ward quite well, doing everythingwell except sleep, on account of the pain in the wrist, con-sidered that there must be some reason why the left wrist didnot recover like the other joints--some organic damage in thejoint itself, and that the case had ceased to be a medical, andhad become a surgical one. He therefore requested that Mr.Canton might see the patient, and express his opinion on him.

26th.--Mr. Canton has seen this patient, and says that thebones of the wrist are affected, that the rheumatic inflamma-tion has organically injured the joint. The patient was there-fore placed under Mr. Canton’s care.

ST. GEORGE’S HOSPITAL.

ANEURISM OF THE TEMPORAL ARTERY; CUREBY COMPRESSION.

As usually seen, aneurisms of the temporal artery originatein wounds produced by cupping. Mr. Erichsen has met withtwo cases of the kind, in which the disease was readily curedby laying the tumour open, turning out its contents, and tyingthe artery on each side of it.Aneurism will sometimes follow in cases wherein this artery

has been opened for the purpose of bloodletting, and injuries tothe vessel are known to give rise to it. On the 1st instant welearnt of an instance of the latter in the person of one of thepupils of the above hospital, who was struck in the temple bya stone, which was followed by an aneurism. The treatment

pursued, as we were informed, was exceedingly simple ; it con-sisted of the occasional pressure of the proximal end of thevessel with the finger, whilst the subject of it was engaged inhis studies, and the - result has been the slow consolidation ofthe sac. This is a most convenient method of cure in thissituation, as it obviates the necessity of inflicting a wound forthe purpose of tying the vessel on either side of the tumour.

Medical Societies.NORTH LONDON MEDICAL SOCIETY.

DR. ANDREWS read a paper

ON PUERPERAL CONVULSIONS.

Those gentlemen who are engaged in obstetric and generalpractice will admit the importance and interest of the abovesubject, and probably join with me in considering it a mostdangerous complication in the lying-in chamber. In thepresence of practical men, it would be bad taste to introducean abstract description of the forms the disease assumes, and Ihave preferred making some clinical remarks on the cases Ihave been called upon to treat, with a view of eliciting com-ments. The first case to which I shall direct your attention isone of puerperal convulsions of an asthenic epileptic character.CASE 1.- Mrs. M-, aged nineteen, the wife of a clerk

residing near Euston-square, a small, slight young woman, ofan irritable temperament, apparently in a delicate state ofhealth, engaged me to attend her first confinement, which wasexpected to take place in January, 1857. There was no historyof epilepsy in early life, or even hysteria, which might induceone to anticipate any deviation from natural labour. Accord-

ingly the pains commenced on the 3rd of the month stated,and proceeded in a regular manner, making great progresstowards the completion of the first stage. I had remained inthe room upwards of an hour, the os uteri was perfectlydilated, and the head advancing towards the perinseum, whensuddenly there was evidence of disturbance of the functions ofthe brain, but nothing like aura epileptica had previously beencomplained of. Her manner was excited, and conversationincoherent ; the eyes suddenly became fixed and the pupilsdilated ; the respiration was sibilant ; the countenance be-came flushed and distorted by spasmodic twitches, and themuscles of the whole body were thrown into a state of convnl-