ST. MARY'S HOSPITAL

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atrophy of the organ ; in these cases the supra-renal body isunaffected, and the other kidney is proportionately hyper-trophied. It would be interesting to ascertain the anatomicaldistribution of the spermatic veins in cases of congenital absenceof the left kidney, for in the absence of the left renal vein theleft spermatic vein would probably empty into the inferiormesenteric vein, or one of the lefG lumbar veins, or else crossthe abdominal aorta to join the inferior vena cava.

WESTMINSTER HOSPITAL.

SUPPURATING SNUFFLES IN AN INFANT, TAKING ON THECHARACTERS OF OZÆNA.

(Under the care of Dr. GIBB.)DISCHARGES from the nose taking on the general characters

of ozsena. are extremely rare in infants, although not at i,all uncommon in adults. On the 15th inst;. a female child,between three and four months old, was brought amongst theout-patients for advice about its nose. At hirth the child took

cold through being exposed during washing, and at once hadthe snuffles. This continued most pertinaciously, and assumeda suppurating character; that is, instead of the usual mucoussecretion, it was now purulent and somewhat offensive, leadingto the belief that either the turbinated bones or the deep re-cesses of the nostrils were involved in some serious mischief.Beyond a redness in the nose itself seen from the front, nothingcould be observed ; and the application of the rhinoscope wasnot attended with any satisfactory results. The child tookthe breast with great difficulty, and had suffered much consti-tutionally in consequence. Alterative powders were ordered,together with matico internally in the form of syrnp (as soldby Newbery), with the view of checking this purulent discharge- perhaps solely arising from the mucous membrane. Maticohas been strongly recommended in France for vaginal and otherdischarges, and employed with the greatest benefit ; and thereseems to be no reason why its good effects should not be seenin such cases as the present. On the 22ud inst. a remarkableimprovement had ensued, and a continuance of the treatmentwas expected shortly to result in a cure.

In a profuse vaginal discharge from a child of eight years,amongst the out-patients, Dr. Gibb found the syrup of matic(to check it in forty-eight hours.

ST. MARY’S HOSPITAL.PERFORATING WOUND THROUGH THE PALM OF THE HAND

FROM A PISTOL SHOT; GOOD RECOVERY WITHOUT DE-FORMITY.

(Under the care of MR. URE.)W. D-, aged sixteen, a healthy-looking lad, was brought

to the hospital on the 25th of October. About half-past eleveno’clock he was in the country, near Harrow, shooting birdswith a pistol. By some accident the trigger was pulled, andhe received the contents of the barrel in the palm of the lefthand, the muzzle of the fire-arm being close to the palm.There was an irregular, punctured, and scorched wound on thepalmar surface of the hand, which passed between the meta-carpal bones of the middle and ring fingers, forming a jaggedand oblique rent of all the soft parts between these bones, sothat the hand appeared as if riven in two, through the flesh-wound. The contents of the pistol having been dischargedclose to the part, caused a perforated wound after the mannerof a ball, as pointed out by Dupuytren. There was no haemor-

rhage to speak of ; indeed, the lacerated and contused characterof the wound necessarily precluded bleeding to any extent.Tne boy’s countenance was good. Wet lint was applied to thewounded surfaces, and strips of adhesive plaster to approxi-mate the torn parts. The hand and forearm were laid on apadded splint. Two days afterwards a bread poultice wasapplied.

October 29th. -The wounds are making favourable progress;countenance good ; pulse 94 ; skin rather hot ; tongue shows awhitish fur ; bowels confined. He complained from the pre-ceding day of some stiffness and uneasiness referred to the backof the head, but could open his mouth perfectly. He wasordered seven grains of jalap «ith three grains of calomel.

October 30th.-He slept soundly during the night ; thereyas free alvine discharge ; the pain and st iffness referred to

the back of the head have subsided ; charcoal poultices wereapplied, whereby the sloughing was arrested and suppurationestablished.By November 16th the wounds were nearly healed, and firm

union of the riven hand had taken place. There was no sink-ing of the fingers, as is prone to occur when a metacarpal bone

. is shattered. There was, however, anaesthesia. of the mid-finger,resulting from the damage inflicted on the digital branches ofthe median nerve.Some apprehension was entertained lest tetanus might super-

vene when he began to complain of stiffness and pain refelrallto the back of the head ; but fortunately there was no further

’ ground of alarm. He returned home on the 21st of November.He has twice shown himself at the hospital since, with the:hand steadilv improving.

ON THE

HOME TREATMENT OF THE EARLIERSTAGES OF INSANITY.

BY GEORGE ROBINSON, M.D., F.R.C.P.,FORMERLY LECTURER ON MEDICINE AND MENTAL DISORDERS IN THE

NEWCASTLE MEDICAL COLLEGE.

NOTWITHSTANDING the great progress made in ametoratmgthe condition of the insane after their admission into asylums,it must, I think, be granted, that very much remains to bedone before the present alarming increase of lunacy can beeffectually checked. And it is equally evident that the realiza- _

tion of this important object depends more upon the skill andinfluence of the great body of medical practitioners than on theutmost efforts of those comparatively few members of the pro-fession whose attention is exclusively confined to cases of con-firmed mental disease.At present, unfortunately, little or no provision is made for

the instruction of medical students in this department of

pathology, and many consequently enter upon practice with-out having any knowledge of the peculiarities of insanity. Butthe experience of all competent observers tends to prove thatthe curability of mental disease is in an inverse proportion toits duration. The medical officers of asylums, who almost ex-clusively possess the requisite information, do not therefore ingeneral see the patient until the disordered state of mind haslasted so long, or given rise to such dangerous consequences, asto warrant the reception of the case into an institution set apartfor the DurDose.

It is not necessary to indicate at any length the evils result-ing from this state of things, both to the patient and to thecharacter of the profession generally. The advantages of pro-per medical treatment are often entirely lost at that very timewhen the disease is most readily combated, and the personaffected, instead of being restored to reason in a few days, may,from this neglect of a critical opportunity, be condemned tomental annihilation for life ; while the limited extent to whichpurely medical ti eatment avails for the cure of confzrnzed in-sanity, or that of a certain duration, has generated an opinionin many influential quarters most hostile to the claims ofmedical science as a director and guide in questions involvingthe pathology of the mind, and even the management of theinsane.Now, in the interest of the medical profession, which is

always identical with that of humanity, I believe it to be ofgreat importance that mental disease should be brought morewithin the domain of general pathology, and, above all, thatthe precious time allowed for treatment at the very commence-ment of the malady should not be wasted or perverted by in-judicious measures. Unfortunately, the experience of medicalofficers in asylums proves that of the patients admitted a cer-tain proportion have previously suffered from, and their chances

. of recovery consequently been diminished by, either positively

. injurious treatment, or, more generally, an absence of thoseexternal favourable conditions which were essential to their

; well-being. The task of diminishing, as far as possible, those. noxious influences devolves on the ordinary medical attendant,- and he is often called upon to exercise his tact and ingenuity. under very adverse circumstances.9 My immediate object is therefore to try to facilitate this

work by bringing to bear on it such special knowledge as I may

I have obtained during some years’ observation of cases of in- sanity both in asylums and in private practice, and such thera-