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ST. THOMAS’S HOSPITAL.

PARALYSIS OF THE LOWER EXTRE1IITIES

FOLLOWING INJURY.

FRFDERICK PERCY, a healtliy-loolring androbust sailor, æt. 22, was admitted June 12,1828, under the care of Mr. Green ; statedthat about six months before admission,whilst on the look out for land, he fell fromthe fore-top-mast of the Atlas East India-man on his buttocks; he experienced a

great deal of pain from his fall, and hislower extremities became immediately para-lytic ; he was bled from his arm, and waslikewise cupped on the loins. The catheterwas introduced for a few days after receiv-ing the accident, and, for some time after-

wards, his urine was thick, and highlyoffensive ; his bowels were not moved tilleight days after the accident, although pur-gative medicine was administered. Whenlie was admitted, there was a projectionof the spinous processes of three of thelower dorsal vertebrae, and complete para-lysis of the lower extremities ; sensibihtynot at all diminished ; bowels regular, andthe urine not deficient in quantity, and

readily evacuated. The treatment adopted,since his stay in the hospital, has been theinsertion of two setons in the back, and theapplication of the liniment of ammonia tohis extremities. He says he is much bet-ter than when admitted ; he can now, No-vember 3, move his legs and toes with fa-cility.

OPERATION OF LITHOTOMY.

The operation of lithotomy was performedat this hospital on Friday, the 24th ult., byMr. Green. The patient, a healthy-lookinglad, xt. 10, had suffered under symptoms ofstone for several years, and came from the

vicinity of Wimbleton, Surrey. Mr. Green,as usual, used the gorget; the stone was

readily grasped by the forceps, but somedelay was occasioned in its extraction by itslage size ; there was considerable pain inthe abdomen two days after the operation,and twelve leeches were applied, whichwere repeated a day or two following. The

boy has been doing well since.Nov. 4. Not a single bad symptom has

occurred. The urine still escapes throughthe opening.

TALIACOTIAN OPERATION.

The man who was operated on by Mr.Green for the formation of a new nose, is

going on well : on the left side it has unitedby adhesion-on the right by granulation.The septum has not yet united, althoughthere are, at this part, some healthy granu-

lations. The granulations near the fore.head, on the left side, are very luxuriant,and there is a considerable discharge of pus.A day or two after the operation, there wasconsiderable discharge through the poste.rior nares into the pharynx, but the matteris, at present, discharged by the nostrils ofthe newly-formed nose. At the upper sur.face, on the right side, there is a dark spot,but, in all other parts, the wound has a

I healthy appearance.

HOPITAL BEAUJON

LARYNGOTOMY.

A YOUNG man, 25 years of age, of a strongconstitution, inadvertently let a needle slipdown his throat. He was instantly attackedwith violent cough and attempts to expec.torate, by which, at last, the thread to whichthe needle was attached was thrown up;this was, however, of little use, for pullingthe thread brought on fresh attacks of

coughing, and caused a very painful sensa.tion in the larynx, as if the needle werefixed in its substance. After the patienthad remained in this state for three dayq,he was, on the 19th of June, brought intothe hospital; at this time he was affectedwith a most violent convulsive cough, dys’pncea, extreme anxiety, intense pain in thelarynx; almost total loss of voice, and verydifficult deglutition. The external parts ofthe neck were red, hot, and swollen. Duringan attack of cough, the thread had againdisappeared. M. Blandin being uncertainwhether the foreign body was in the larynxor in the œsophagus, put off the operationuntil the re-uppearance of the thread slionldenable him to form a more certain diagnosis;meanwhile leeches, venesection, &c., were

employed. The above symptoms continued,but without indicating much danger, till the21st, when the thread, having been againbrought up by coughing, many attemptswere made to withdraw the needle by it,but in vain ; in depressing the tongue withthe linger, it was evident that the threadentered the larynx on the left side of the

epiglottis, and after a fruitless attempt toextract the needle bv means of a curvedtube, laryngotomy was resolved on. The

swelling of the neck was so considerable;that it was impossible to find exactly thecrico-thyreoidcan space. M. Blandin madean incision in the middle of the laryngealregion, and by slowly dissecting the cellulo-fibrous mass, into which the subcutaneousmuscles were changed, arrived at the crico.thyreoid membrane, which, after tljeliyatureof a few small arteries, was transversely

187

opened. A director was carried throughthe aperture, and the thyreoid cartilage di..vJded on it in its whole iengt!); a violent,but short attack of cough followed this

part of the operation ; when it had subsided,some attempts were made to extract the

needle, but the extreme agitation whichfollowed each introduction of the forceps,made M. Blandin desist from them. Thewound was dressed with a piece of adhesiveplaster, with an opening in the middle for thepassage of air. The act of swallowing wasnow attended with much less difficulty,but thefluids escaped, for the most part, through thewound. The thread had, during the ope-ration, been involuntarily swallowed. Thenext morning the needle, an inch and a

half in length, was found fixed in the plaster,and easily extracted. From this time allthe symptoms abated, aud the wound slowlyhealed, at the end of September, a smallfistulous opening, and some hoarseness, stillremained.—Journ. Hebdomad. de Médec.

HOTEL DIEU.

CATARACT.

lN twenty-one cases of cataract, whereM. Dupuytren performed keratonyxis, thefollowing were the results :-of the pati-ents three were under ten, seven under

fifty, and eleven above fifty years of age ;in eleven cases the operation was followedby immediate success ; in six, the patientsrecovered their sight after a month ; in fourcases only the operation failed ; in two ofthem amaurosis, in one opacity of thecornea, and, in another, inflammation andatrophy of the eye ensued.

ANEURISM OF THE INNOMINATAAND CAROTID.

[Communicated by Mr. WARDROP.]

Aneurism nf the Innomiata and Root of theCarotid, successfudly treated by T’ying the

Carotid Artery.

By D. EVANS, Esq. Surgeon at Belper,Derbyshire.

WILLIAM HAi.1,, mtat. 30, a butcher andhorse-dealer, an athletic and spirited young-man, about five feet six inches. high, hasbeen accustomed to laborious exercise, fre-quently riding from 70 to 100 miles a day,and has always enjoyed excellent health,until the appearance of the following symp-toms :-About 14 months ago he was seizedwith shortness of breath, troublesome cough,

and tightness over the chest, after much ex-ertion, especially in walking fast up a hill.These symptoms continued until the 6thMarch, when he had an attack of bronchitis,which he attributed to cold. His expectora-tion was copious, consisting of mucus

slightly streaked with blood, and his coughcame on in violent paroxyms, which werefollowed by a sense of suffocation.On the 10th of March, afler a fit of

coughing, a soft pulsating tumour, aboutthe size of a walnut, suddenly made its ap-pearance behind, and extending a littleabove the right sterno-clavicular articula-tion, and covered, externally, by the sternalportion of the sterno-mastoid muscle. Thetumour was greatly diminished by firm pres-

, sure, but could not be made to disappearentirely.The pulsation of the tumour, which was

synchronous with that of the heart, wasl increased in force by piessure upon the

right subclavian artery, and was diminished,and sometimes completely arrested, by pres-sure upon the right carotid, above the tu-mour. The pulsations of the right carotid,and subclavian arteries, were stronger thanthose of the left ; but there was no appa-rent difference in the pulsations of the ra-dial aiteries.

As soon as the tumour made its appear-ance, the cough and dyspnœa, ceased to betroublesome, and his health was soon re-

established.. His chest sounded well uponpercussion, and the respiratory murmur

was distinctly heard all over it. No unna-tural pulsation could be detected, by theuse of the stethoscope, between the tumourand the heart. A loud and powerful pulsa-tion was heard over the tumour, unattendedwith any unusual sound.

’

In taking into consideration the situation.of the tumour,-its sudden appearance, aftera violent paroxysm of coughing, and itssoft pulsating character, together with thesymptoms above enumerated,—little doubtcould be entertained of its nature, and Iconcluded that the root of the carotid arterywas the seat of the disease.

Considering this a favourable case for theoperation lately revived, and so ably advo-cated by Alr. Wardrop, I was’induced toobtain the opinion of two eminent surgeonsin London respecting its propriety. Both,however, disapproving of the operation, itwas, therefore, determined, with the ap-probation of my friends, Mr. Bennet, and

Mr. Brown, of Derby, that a fair trial; should be made of Valsalva’s plan of treat-ing aneurisms., The nature of the disease was fully ex-plained to the patient, who, fortunately, wasa man of strong sense and most determinedl resolution, and, from his employment lead-, ing him to study the diseases of horses,