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neck, and two grains of calomel, with aquarter of a grain of opium, to be taken

twice a day.On the LOth, the mouth had become sen-

sibly affected, and the vision of the right eyehad considerably improved. On the i5th,a further amendment had taken place ; a

blister had been applied on the 13th. Onthe 20th, there was no appearance of diseasein the right eye ; the left eye remained thesame, the extract of belladonna appliedaround the orbit did not increase the sizeof the pupil. A few days after this last

’report, the patient was dismissed the Hos-pital on account of some irregularity ofconduct.

EXTRAORDINARY CASE OF RETENTION OF

URINE.

In No. 206 of this Journal, published sevenweeks since, was related a case of retentionof urine, which we entitled " extraordi-

nary," and as an exemplification of the°‘ sound chirurgical knowledge" of thefit and capable " men, which the Court ofExaminers let loose upon the public to prac-tise the ’ art and science " of surgery. Amore flagrant instance of malpractice wenever witnessed or detailed, and we areglad to find that the local authorities-thechild having been an inmate of a workhouse- are about to investigate the affair. Asthe veracity of the statements published byus has been impeached by the chief delin-qztent in this affair, we will briefly revert tothe particulars :-The patient, a child sevenyears of age, was brought to the Hospitalon the 30th of July : it had an enormouslydistended bladder, and was in a dying state- expiring about half an hour after its ad- Imission. The urine was drawn off without

difficulty, but on examination after deatha false passage was found, taking its coursefrom about the opening of the seminalducts, and passing along the under part ofthe neck of the bladder, between it and therectum. Thus much of the symptoms ; theaccount given of the preceding treatment(which is confirmed by the master of theworkhouse, a highly respectable man) was,that the child had been. under the care ofthe surgeon (1) for three days, but he didnot adopt any measures to relieve it fromthe retention of urine, until the morningof its admission into the Hospital, whenhe attempted to introduce a catheter, but didnot succeed. It is endeavoured to cast the

stigma of making a false passage on thedresser of the Hospital, Mr. Ward : whichis totally untrue. But, even admitting thatthe false passage was made by the dresser-setting this aside altogetlier-liow standsthe affair ? ’Vhy thus-the child had beenfor three days labouring under retention ofurine, but it was undiscovered until the

third day ; secondly, when the grand dis.covery took place, attempts were made topass a catheter, but the surgeon (dexterousfellow!) could not or did not pass the in-strument ; and, thirdly, the poor child wassent to the Hospital in a dying state, whenit must have been obvious to any man pos-sessing the slightest share of professionalknowledge, that the case had proceededbeyond redemption.

GUY’S HOSPITAL.

IN Mr. Bransby Cooper’s admission ofpatients on the 2.5th of July, were the fol-lowing cases, which, although not possessingso much interest as to require a minute de-tail, are worthy of relation in brief.ERUPTIVE DISEASE FOLLOWING THE USE

OF MERCURY.

This was one of those perplexing cases, of £daily occurrence, in which it is doubtfulwhether the symptoms are the relics of

syphilis or the product of mercury-casesentitled pseudo-syphilis.

Lazarus Ward.—M. C., ætat 32, says, thathe had venereal sores eighteen months ago ;which got well under ’the use of mercury,that about twelvemonths afterwards he haderuptions all over the body, for which mer-cury was given until the mouth was sore.He was subsequently admitted into Cor-nelius Ward of this Hospital, with erup-tions and pains in the limbs, and mercurywas again given during a period of ten

weeks. The cheeks are covered with athin yellowish crust, and the skin aroundis inflamed ; there are purple coloured spotsin the skin upon the limbs and body, andthe scrotum is affected with a watery exu-dation. The disease on the face commencedwith small pimples, which burst and gaverise to a watery discharge, the incrustationoccurring subsequently. There is thicken-

ing of the periosteum on the left tibia, andalso on the right tibia in a less degree ; hesuffers pains in the limbs, especially at night.The following measures were pursued :-

a warm bath twice a week, a dilute lotionof the sulphate of zinc to the face ; decoc-tion of sarsaparilla, with the extract, andone-sixteenth of a grain of the oxymuriateof mercury, to be taken three times a day.On the 24th of August a grain of calomel,with one grain of opium, were ordered tobe taken at bed time, and a blister appliedto each shin.A report made on the 5th of September,

at which time he was in the Hospital, statesthat there are still pains in the limbs anderuptions occasionally occurring, but thedisease on the face is removed ; the samemeans are pursued.

831

NECROSIS OF THE METATARSAL BONE OFTHE LITTLE TOE.

Lazarus Ward.—J. H., eleven years of age,and apparently healthy, states that he re-ceived severe injury to the foot, which wasfollowed by great swelling and pain in themetatarsal bone of the little toe. Thereare two sinuous openings on the upper part,with large florid granulations at the com-mencement of each, and from these aper-tures several portions of bone have comeaway. The metatarsal bone is evidentlyvery much thickened throughout its wholeextent, and a probe introduced at eitheropening, strikes upon a portion of diseasedbone.-Ordered to take half a drachm ofpowder of bark, with three grains of rhu-barb and ten of soda, three times a day.The dilute nitric acid ’lotion to be injectedinto the nstulae.A report made on the 5th of September

states, that there is much less thickeningof the bone generally ; several portionshave come away, and the sinuous openingsremain. He continues in the Hospital.

DISEASE OF THE SHOULDER JOINT.

Lazartts Ward.—A. Bennett, 14 years ofage, of strumous habit, has been ill two

years and a half, with disease of the shoulderjoint. There are several sinuous openingsaround the shoulder joint, some of themnearly as high up as the acromial process,and others on the back part apparentlyleading to the scapula ; there are also scarsat the scapular extremity of the clavicle.The upper portion of the humerus as grasp-ed by the hand, has the feel of being muchenlarged ; there is but very slight motion inthe joint, and great pain is excited on mov-ing the limb in the slightest degree. Therehas never been any exfoliation of bone, andthe disease commenced with violent pain,followed by much constitutional derange-ment.

Mr. Cooper is of opinion that the headof the humerus, as well as its opposingsurface, the glenoid cavity (and probably afurther portion of the scapula) are diseased;that partial anchylosis having already takenplace, the indication for treatment is to en-courage that process, by means of rest anda soothing plan of treatment. The patientordered to carry the arm in a sling, to per-mit as little motion as possible, and largelinseed meal poultices to be applied warmover the shoulder ; two grains of rhubarb,with ten grains of carbonate of iron, andthree grains of quicksilver with chalk, tobe taken three times a day.On the 18th of September, having visited

the patient at intervals since his admission,we find him much improved in appearance ;the shoulder joint has now become com-

pletely fixed, and pain is not produced onmaking slight attempts at motion. It is

singular to observe the extraordinary mo-bility which the scapula itself under thesecircumstances has attained, it readily fol-lowing the different motion of the arm :

several of the sinuses have healed. Mr.Cooper has directed the lad now to use verygentle motion ; it is to be feared, however,that the anchylosis is of too firm a nature toallow a reasonable hope for much benefitfrom this measure. At one period, duringthe patient’s sojourn in the Hospital, he wasseen by Mr. Key, who hinted the proprietyof removing the head of the humerus, butthis operation was considered by Mr. Cooperto be inadmissible on account of the disease,as he believed, affecting the scapula also.

CARCI’,’OMATOUS DISEASE OF THE BREAST.-

OPERATION.

Jane Palmer, 40 years of age, of dark

complexion, but healthy in appearance, wasadmitted into Charity Ward on the 5th ofSeptember, under the care of Mr. B. Cooper.The history of her case was as follows :—she was married, but never had borne anychildren ; her catamenial discharge was

regular in its occurrence, but less in quan-tity than formerly. Two years ago she dis-covered a small hard lump in the breast, itgave her no pain, and she distinguished it

merely by accident. For twelvemonths thistumour remained nearly stationary, but atthe commencement of another year it en-

larged rapidly, and she now experienceddull aching pains in the breast, especially atthe periods of menstruation . Thus muchof the history of the disease ; with respectto its appearance at the time of admission,the whole volume of the breast, as comparedwith the opposite, was greatly increased-itwas moveable, and very heavy to the feel.The nipple was slightly retracted, the outertwo-thirds of the mammary glands was con-solidated into a mass of stony hardness,whilst the inner third of the gland was morefirm than natural. There were numerous

large veins to be observed running over thebreast ; the skin on the outer part, near tothe anterior fold of the axilla, was of apurplish colour, and had somewhat of ashining appearance, as though ulcerationwould speedily ensue. In the axilla therewas an enlarged gland, which the patient

* We find it written in the " schoolbooks," as Jemmy Johnson says when wish-ing to pose an antagonist with high autho-rity, that " lancinating pain " is an invari-able attendant on cancer. This, however,is by no means the case ; we have seenmore than twenty instances to the contrary.

832

said had existed for seven or eight months,but had never occasioned pain. Mr. Cooperhavingexpressed his opinion,that the diseasein this case was of a malignant nature, in-formed the patient that the only means ofrelief consisted in the extirpation of theparts affected, to which the poor womanassented.On Friday, Sept. 17, the operation was

performed ; it consisted simply in makingtwo oblique elliptical incisions, which

meeting at their apices, included the dis-eased mass, and this was removed by a

.subsequent process of dissection. The

nipple was included in the part whichwas removed. A section of the tumourshowed its true carcinomatous character,there were several minnte yellowish spotsto be observed, and these were much softerthan the surrounding parts. The diseased

axillary gland was removed, but it was sodeeply situated that the pulsations of theaxillary artery could readily be felt in de-taching it from its cellular connexion bymeans of the fingers.-It may not be unim-portant to observe, that it is the usual prac-tice in this Hospital to remove a malignanttumour of the mamma, although one or

more of the axillary glands may he en-

larged, which in that case are also extir-

pated. It is found that although the chancesof the disease returning, under such circum-stances, are greatly increased, yet that invery many instances the disease has not

recurred ; and this forms a sufficient reasonfor operating rather than consigning thepatient to be a slow but sure victim ofone of the most horrible, loathsome, andpainful disease’s to which mankind is liable,

WINCHESTER COUNTY HOSPITAL.SCIRRHOUS TUBERCLE OCCURRING IN THE

MALE BREAST.

Ros. LITTLEFIELD, set. 23, labourer, wasadmitted into the Hospital, under the careof Mr. H. Lyford, with a scirrhous tuberclesituated under the nipple of the right breast.The patient first accidentally observed a

fulness under the right nipple about threeyears prior to his application for admission,but it was not a source of any inconveniencefor some considerable period; at length,however, the parts under the nipple be-came quite hard, attended with an occasionalpricking sensation. Within the last twelvemonths the swelling has become more dis-tinct and indurated, accompanied with most

severe lancinating pain through the nipple,from which part there is occasionally a slightdischarge. On examination the tumour

appears to be perfectly detached, except atits anterior part, where it is most firmlyconnected with the nipple ; it is extremelyirregular and very hard, and of the size of avery large walnut. There is no enlargement

under the axilla. The patient was apprisedof the necessity for removing the part, which

L he readily consented to, and which was ac-cordingly performed by Mr. Lyford, in theusual mode, by a semicircular incision, ofcourse including the nipple. No arterieswere secured. The edges of the wound

r were brought together by one suture, and, the application of sticking-plaster and hand-age. The suture was removed on the firstr dressing, and the wound was completely1 healed in the course of a week.) A section of the tumour was made afterits removal, and exhibited a good specimenof true scirrhus. Its interior seemed to

have been converted into a substance some-what resembling cartilage, with ligamentousbands passing off in every direction. Thet blood-vessels by which it was supplied, ap-r peared to be extremely few and minute.- illr. l,yford stated, that he had removed asimilar disease from the breast of a females only eight years of age, and that he was not- aware of any case of a similar disease occur-a ring so early in life having been recorded.

TO CORRESPONDENTS.

COMMUNICATIONS have been receivedfrom Mr. SPILDHURST—Mr. WEBB—Mr.CHERRY—Mr. COOPER-Mr. BEDINGFIELD- H. A. B.—SENEX—AN EDINBURGH SUR-GEON— C. B. S.—T.G.—CONSTANT READER—JUVENIS—ANTI-LITIGANT—A PUPIL—BARBATUTUS—A GRADUATE OF EDIN-BURGH—Z.—I. C.-D. E.—L. J. B.—TYRO—R.E.—M. F.—R.Y.—VERITAS—ASUR-GEON—Mr. P. CAMPBELL—Mr. J. RAE—CELSUS—and a Gentleman, who dates hisletter from Phillimore Place, whose namewe cannot decipher.The dialogue alluded to by " A Friend

to THE LANCET," was published for the pur-pose of preventing a repetition of such dis-gusting and unfeeling practices." A Pupil of the London Hospital" is re-

. quested to favour us with his address.

[At p. 78:) of our last Number, 2d col.line 1., for prvspenity read prospects.]