31

HOPITAL ST. ANTOINE.

SUPPURATION OF THE LEFT KIDNEY.—COM-

MUNICATION BETWEEN THE CAVITY OF

THE ABSCESS AND THE COLON.

JosFrxINE C-, eetat. 29, of scrofu-lous habit, was admitted about the mid-dle of December 1829. She stated, thatabout six months ago, she had had violent

pain in passing her uriise, which was ratherhigh-coloured; this pain gradually subsided,but a tumour formed in the region of theleft kidney, and had, at her admission, at-tained to such a size, as almost to occupythe whole of the left lumbar region. It didnot form a great prominence, but was felt tobe rather hard and tense. The urine had,meanwhile, become of whitish colour, anddeposited a sediment of faeculent matter.During the beginning of January, thoughthe urine was natural, the tumour becamethe seat of violent pain, especially on pres-sure, and on couglling, and the patient ap-peared to be altogether in a sinking state.M. Kapeler ordered frictions of hydriodateof potash, and cataplasms with opium. Five

days after this treatment, the tumour hadsomewhat diminished in size; the patientwas affected with diarrhoea, and’said thatshe felt the tumour to be evacuated by thestools : on the 17th the diarrhoea still con-

tinued ; the tumour, however, had becomemuch smaller and softer ; the stools werenot examined until the 19th, when they of-fered nothing unusual : during the followingdays she continued to sink, and died on the24th. On examination, the left kidney wasfound to be transformed Into a large, soft,and fluctuating mass, closely adherent to thesurrounding parts, consisting of four or fivepurulent cavities, containing a great quan-tity of viscid, greyish, and extremely foetidmatter; the parietes of these excavationswere very thin, of rather hard texture, andbrownish colour. The mesentery and Irsid-dle portion of the sigmoid flexure of thecolon adhered to the lower portion of thetumour; and the inner surface of the colonexhibited a laige circular ulceration whichformed a communication with one of thecavities of the kidney. The right kidney,and the other organs, exhibited no particularmorbid change.-Lanc. l’;’anç. ,

HOPITAL DE LA CHARITE.

RESECTION OF TIIE SECOND METATARSAL

BONE.

I-.EORAS, of scrofulous constitution, 20

years of age, was admitted on the 29th ofJanuary : about seven weeks previously, anabscess had formed on the back of the foot,

and having burst spontaneously, left a fistu.lous ulcer ; on probing this, the second me-tatarsal hone was found diseased at its tarsalend. M. Itoux, under whose care the pa-tient was, determined upon performing theexarticulation of this bone, and removingthe diseased portion by means of the chain-saw. The operation was performed on the27th of February, in the following manner:an oval incision was made over the diseasedportion of bone, and its tarsal joint, com-prising the fistulous aperture ; the skin

having been dissected off, and an artery tied,the soft parts were detached from each sideof the bone. and the chain-saw carried under,and extracted at the other side of the bone.]’his part of the operation was extremelydifficult. M. R. first endeavoured to intro-duce the chain by means of a needle, butfinding this impracticable, tried a silverprobe ; and as this also did not succeed, asilver stick in a director. These attemptslasted no less than twenty-five minutes, andM. R. was going to withdraw his instru-ments, and to give up the operation altoge-ther, when he found the director so nrmiyfixed, that it was impossible to extract it ;he accordingly set again to work, and at lastsucceeded in carrying the stilet along thedirector, and extracting it on the other sideby a pair of forceps; the chain-saw wasthus placed under the bone; but when M. R.renewed h:s attempts to extract the director,they were as unsuccessful as before, and hewas obliged to defer doing so till he haddivided the bone : this having been done,though with great difficulty, the directorwas extracted without any great efforts.The cuneo-metatarsal articulation was now

opened, and the operation thus terminatedwithout any further difficulty. It bad lasted

forty-two minutes, and appeared to havebeen extremely painful. The removed por-tion of bone was almost entirely perforatedby caries; its anterior portion, as well as itsarticular extremity, was healthy ; so thatthe disease appeared to have been removedin its whole extent.-Ibid.

HOPITAL MILITAIRE DE LAGARDE.

EXARTICULATION OF THE UPPER ARM. _

AL. BARCOTIN, aetat. 24, of scrofulousconstitution, had, at the beginning of lastyear, his left thumb removed by M. Larrey,on account of caries ; some time afterwards,he re-entered the hospital with an abscessat the elbow joint, which was opened by thecautery ; this was followed by profuse sup-puration, and the formittion of other ab-scesses and sinuses ; the bone became denud.ed, and was found to be carious to a greatextent; .the soft parts ware wasted, and