was made with the scalpel on each side of the iliac artery, and a ligature was carried under it and tied. The wound was brought together with a suture and adhesive plasters. No difference in the temperature of the extremities followed, and, on the third day, the wound had united. On the seventh day, the wound was disunited by a discharge of sanies and pus. Three weeks after the operation, the ligature came away, and the wound had nearly healed; and at the end of two months, the man was discharged in good health, with a free use of his limb, and scarcely any tumour. XVII. On Lithotomy. By PHILIP M. MARTINEAU, Esq. Senior Surgeon to the Norfolk and Norwich Hospital. MR. Martineau is an advocate for the lateral operation, and attempts to prove that Mr. Carpue's reasons for preferring the high operation are by no means conclusive. In the first years of his practice Mr. M. was not very successful, and, finding that his misfortunes arose from the use of the cutting gorget, he laid it aside. During the last seventeen years, he has employed the knife only, and the blunt gorget as a conductor for the forceps; and in this period, he has only lost two, out of eighty-four patients. He subjoins a table, showing the age, name, and event of every case. The first incision is made nearly in a line with the raphé, and the staff he uses has a groove much wider and deeper than is commonly made. Feeling the groove of the staff, he introduces the point of the knife into it, as low down as he can, and cuts the membranous part of the urethra, continuing the knife through the prostate into the bladder. Instead of enlarging the wound downwards, he turns the edge of the blade towards the ischium, and makes a lateral enlargement of the wound in withdrawing the knife. He takes the staff into his left hand, while he introduces the blunt gorget with his right; and, after the latter is within the bladder, he introduces his finger, and endeavours to feel the situation of the stone. He always uses the straight forceps, and says it will be found more easy to extract a stone whole by rather large forceps, than with flat or small ones. After the operation, a piece of lint is laid over the wound, and the air is excluded as much as possible, by a pledget of tow it being Mr. M's. object to heal by the first intention. Coagula are removed by the finger pushed through the opening into the bladder, or by a female catheter. Pain should be relieved by opium, and abdominal tension by fomentations, blisters, and aperients. Mr. M. never bleeds his patients after lithotomy, and observes, that he has witnessed such debility succeed venesection, as could not be overcome; and he considers leeches altogether useless. The diet for the first two or three days, is mild, and, if fever and inflammation are absent, it is afterward more generous. In general, Mr. M. believes, that death is oftener produced by exhaustion and despondency, than by acute disease. In Norfolk and Suffolk, stone in the bladder is almost exclusively confined to the poor, and it appears often in infants, before diet can have any influence. The food of the poor is neither bad nor sparing, and the people are remarkable for cleanliness. It is a curious fact, that after the operation, scarcely a case occurs, in which the stone is generated a second time; and when that does happen, it may usually be traced to the breaking of the stone, whereby a fragment is left behind as a future nucleus. XVIII. Case of Cynanche Laryngea, in which Tracheotomy and Mercury were successfully employed: with Remarks. By WILLIAM PORTER, Esq. A. M. Surgeon to the Meath Hospital and County of Dublin Infirmary, and to the Dublin General Dis pensary. THE patient was strong and about thirty years old. Symptoms. The face pale and swollen, and the lips livid. "He sat with his mouth closed, but his nostrils widely extended; his eyes seemed protruded and starting from their sockets, but at the same time the conjunctiva appeared very white, and covered with a watery suffusion. There was altogether an expression of indescribable anxiety in his countenance. His pulse was hurried but not irregular; his breathing very laborious; he made two, three, or even more attempts at inspiration for one expiration, and his muscular heavings and convulsive struggles for breath were truly painful to behold. He breathed with a peculiar hissing or whistling sound, giving a distinct idea of the forcible passage of air through a contracted aperture, and he had almost lost his voice, the utmost endeavour at speech amounting only to an indistinct whisper." 416. Treatment. Ten grains of calomel. The veins of both arms opened at once, and thirty or forty ounces of blood withdrawn, the patient being erect. Two hours after this the pulse was scarcely to be felt, the extremities were cold, and he was almost insensible. While in this state tracheotomy was thought necessary. "An incision was made nearly three inches in length, commencing a little above the cricoid cartilage, and continued towards the sternum, dividing the skin and cellular substance down to the muscles. At this period of the operation, two small lymphatic glands were exposed, which protruded forwards, and interrupting the view of the parts, were cut away. The incision was then carried deeper, still preserving the exact central line of the neck, until a fascia covering the trachea was exposed; and here lay the greatest difficulty of the operation. The trachea was moved upwards and downwards behind this fascia, according to the patient's exertions to breathe, and it was impossible to open it satisfactorily until this membrane was completely removed, a proceeding that occupied some time; it was however effected; the trachea was laid bare, in extent about three-fourths of an inch, and a circular portion removed, the diameter of which might have been nearly one-fourth of an inch." 419. The moment the air was admitted through the wound into the trachea, the patient felt immediate relief, and began to recover his sensibility. A silver tube was passed into the aperture and retained by means of tape, Although the central slip, connecting the thyroid lobes, was completely divided, there was scarcely any bleeding. One large thyroid vein is sometimes found running along the middle of the trachea, which should always be carefully avoided. Two more ten-grain doses of calomel were given at intervals after the operation, and warm wine and water allowed. The second day, the canula having slipped out, the symptoms returned, but were speedily relieved. Three more ten-grain doses of calomel were taken, and on the third day two doses of the same strength, although the bowels were open. On the fourth day salivation commenced, and the man made a good attempt to speak; and on the fifth, the opening into the trachea being found too small, it was enlarged, so as to render it three-eighths of an inch long .From this time nothing particular occurred to retard his recovery; and on the 21st day after the operation the wound in the trachea had united, and the patient was soon afterward discharged in perfect health. When inflammation in the larynx assumes an acute form, Mr. Porter conceives that it is probable an effusion of fluid may take place in the submucous structure in such quantity, and with such rapidity, as to close up the passage and produce suffocation. "A melancholy proof of this lately occurred in the person of a young gentleman of high attainments; he only complained during the day of sore throat, and on the morning following was found in his bed quite dead. On dissection, the rima glottidis was found completely closed by the oedematous swelling of the mucous membrane." P. 428. As soon as the nature of the disease is ascertained, and it is found to be of an active nature, Mr. P. advises as early an operation as possible, with the view of preventing the formation of disease in the lungs, as well as of affording speedy relief to the sufferings of the patient. "If, then, the disease has occurred suddenly, and its symptoms have attained an alarming height in a short space of time, if there is expressive difficulty of breathing, and laborious muscular efforts to carry it on, the practitioner has but one resource, and that one will be in an operation. And although it is very possible that even in this he may not prove successful, if diseased action has already been formed in the lungs, yet he will be justified in the attempt, from the consideration that it is the only hope of safety he can hold out to his patient, and he will, at all events, be in some degree rewarded by the immediate alleviation it will afford to the most distressing symptoms." 437. In the chronic as well as in the acute form of the disease, there is Vol. II. No. 8. 5 X no medicine, which has yet been found to possess such efficacy as mercury, when administered in such quantity and in such a manner as will rapidly bring the constitution under its influence; and in these cases, should any sudden or severe axacerbations threaten the lungs with disease, bronchotomy may be safely resorted to, and will probably be followed by a favourable result. It is an unfortunate circumstance, however, that the diagnosis of laryngeal inflammation is rendered difficult by the similarity of symptoms produced by different affections of the larynx. We have thus attempted an outline of Mr. Porter's excellent paper. It is, however, so full of useful information on the subject of laryngitis, that we think our readers will be much gratified and instructed by an attentive perusal of the original publication in the Society's Transactions. . XIX. Case of a large adipose Tumour successfully extirpated. By Sir ASTLEY COOPER, Bart. F. R. S. Surgeon to Guy's Hospital. NICHOLAS PEARSON, aged 57, was admitted into Guy's Hospital with an adipose tumour on the abdomen, which had been growing about forty years, and was at first no larger than a pea. Its dimensions at the time of his admission were prodigious : : "Measuring one yard and a quarter around its greatest circumference, and eighteen inches around its neck, extending, when he was sitting down, to his knees it had increased most rapidly during the last three years, but up to the time of his admission, he expressed no other inconvenience than that of the weight he had to support, which of itself rendered him so perfectly incapable of obtaining his bread, that he was driven to the necessity of its removal." P. 443. Operation." The first step of the operation was to draw the tumour to the patient's right side, and then to make an incision through the integuments and cellular membrane at its base; separating the swelling so far from its connexions as to be enabled to ascertain that it was not connected with hernia, or in any way with the abdomen; but in this investigation it was found, that a considerable portion, much more sensitive than the rest of the tumour, did project from the swelling into the umbilicus, but that it was not a hernia. Having ascertained this important point, the remaining part of the operation consisted in a simple dissection, with the application of ligatures to the veins, which were of considerable size, and bled freely, and to the arteries, which, considering the bulk of the tumour, were not so much enlarged as might have been reasonably expected. The patient lost but an inconsiderable quantity of blood during the operation." 443. The weight of the tumour, independently of the blood it had contained, was 37 lb. 10 oz. No bad symptoms followed, and the wound healed principally by granulations. In eight days the man was able to walk in his ward. APPENDIX I. Abstract of the Account of a Case of Adhesion of the Labia Pudendi in a Negro, obstructing Delivery, drawn up by DR. WILLIAM RUSSEL, of Jamaica: presented to the Society by WILLIAM ROOTS, Esq. Surgeon of Kingston on Thames; dated, Cascade, St. Mary, Jamaica, June 12, 1819. APPENDIX II. Account of a Child of three Years of Age, in whom there appeared Signs of Puberty. Abstracted from a Paper communicated to the Society by GILBERT BRESCHET, M. D. Superintendent of the Anatomical Department of the Faculty of Medicine in Paris; dated, December, 1820. A boy, between three and four years old, with the same sign's of premature puberty, is now exhibiting in London. XIV. Opiologia; or Confessions of an English Opium-Eater; being an Extract from the Life of a Scholar.* “Charmed with that potent drug, th' exalted mind "All sense of wo delivers to the wind; "It clears the cloudy front of wrinkled care, Odyssey, Lib. IV. WHEN we first glanced at this production, we considered the title as a mere vehicle, through which some romantic or satirical tale was to be conveyed. On reading a little farther, we soon perceived that this first impression was erroneous, and that these confessions bore intrinsic marks of authenticity. We have since been satisfied, by proofs the most unequivocal, of the respectability of the personage, and the truth of the narrative. The perusal of this interesting paper recalled to our memories many images and sensations of early life, now nearly obliterated by time, though stamped, at the period of occurrence, with more than common force of impression. We too were opium-eaters-but on a very limited scale, and for a very short time, compared with the author now under consideration. We well recollect, however, the inexpressible delight produced by opium, when prostrate on the bed of * See London Magazine for September and October, 1821. |