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284 lower part being smashed to pieces, and driven into the joint, a splint, isolated, run- ning some way up the shaft, had become dead. Numerous splinters penetrated the muscles, detached as well as undetached from the greater portion of the shaft, and a comminuted fracture extended nearly as high as the trochanter major. HOTEL DIEU. VARIOLOID ERUPTION, FOLLOWED BY SCARLET FEVER. - BEr.Arn-, xtat 19, was, on the 3d of May, admitted at the I-lotel-Dieu, under the care of M. Husson. He had, for three days, been affected with violent headach, pains in the limbs, sore throat, nausea, fever, and a varioloid eruption, though he had been’vac- cinated in his second year, and had had the small-pox afterwards. From the 3d to the 10th, the fever increased, the tongue became dry, and covered with a crust. Having at this period exposed himself to cold, the eruption was suddenly suppressed, the pus- tules dried up, or became of a violet colour, and general debility, with diarrhoea, came on. He was twice bled by leeches applied to the abdomen, but the typhoid state increased, delirium succeeded, and the looseness was accompanied by tenesmus. On the 18th, a scarlatinous eruption appeared on the back and chest, with difficult deglutition and hoarseness. The fever subsided a little, and the new eruption terminated in vesicles, but the debility, delirium, and diarrhoea augmented; when, on the 27th, a slough was formed over the sacrum, and on the 30th the left parotid began to swell. Dur- ing all this time, nothing but mucilaginous remedies were administered; but another physician having now taken charge of the patient, bark, wine, and strong beef-tea were given. Fluctuation being felt in the tumour of the parotid, it was opened on the 6th of June ; but the patient sank and died on the 8th. On examination, the mucous membrane of the intestinal canal was found slightly inflamed; and the reporter of the case seems very much inclined to ascribe the fatal event to the irrational treatment of the physician who succeeded M. Husson. Although we cannot subscribe to this opi- nion, we cannot but consider it injurious that a patient should be passed from one physician to another, which, our readers are perhaps aware, occurs in nearly all the larger hospitals of Paris. GANGRENOUS LARYNGITIS AND BRONCHITIS. A labourer, 17 years old, had for some time been affecled with a very troublesome cough, when, after an excess in drinking, he was taken with shivering, fever, general debility, violent headach, sore throat, and diarrhoea. Some leeches were applied to the throat, and, on the 5th of April, thepa. tient was admitted at the Hotel-Dieu. At this period the heat was moderate, the skin dry, the pulse very small and frequent, the abdomen somewhat tender, the tongue dry and red, the mouth and nose filled with mu. cus, the breath very fetid, the throat very painful, and deglutition difficult. The ton. sils and soft palate were covered with a thick, white, greyish mass, the voice was hoarse, respiration difficult and stertorous, and a thick mucus was expectorated; eight leeches were applied to the epigasttium. On the 6th, the smell of the breath was truly gan. grehous ; the countenance was very pate, and expressive of anxiety ; the pulse could not be felt, and the voice was hardly audible. Thirty leeches to the throat, and sinapisms to both arms, were ordered; but the patient died on the same morning. On examination, the whole cavity of the mouth was of a livid colour, and lined with a thick albuminous mass ; the tonsils were swollen, and of a dark-red colour. The whole extent of the larynx, trachea, and the larger bronchial divisions, were covered by a false membrane of a white colour, and gradually decreasing in thickness. The upper part of the right lung was hepatised, and very firm ; the left lung was healthy. The mucous membrane of the stomach was red, and, on the great curvature, beset with granulations.—La Cliniqtte. ABUSES IN ST. BARTHOLOMEW’S HOSPITAL i To the Editor of THE LANCET. SIR,—Since 1 last troubled you with some observations on the abuses at St. Bartholo- mew’s Hospital, various chang’es have taken place, another winter-campaign has com- menced, new house-surgeons have bem appointed, and sundry dressers installed in their situations ; thus, as there is a greater sphere of action, so is there an adequate proportion of abuse : should you therefore think fit to insert the occasional remarks, I shall send you in the couise of the winter, it will still further prove that you are, what you have ever been, the pupil’s friend. With respect to the demonstrations at St. Bartholomew’s, they have been for the last year or two, unquestionably the most inferior in London ; and it would become Messrs. Abernethy and Stanley, if they have any regard for their own interest, and the pupils’ welfare, to pay a little more at. tention to the qualifications of those whom

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284

lower part being smashed to pieces, anddriven into the joint, a splint, isolated, run-ning some way up the shaft, had becomedead. Numerous splinters penetrated themuscles, detached as well as undetachedfrom the greater portion of the shaft, and acomminuted fracture extended nearly as

high as the trochanter major.

HOTEL DIEU.

VARIOLOID ERUPTION, FOLLOWED BY

SCARLET FEVER.

- BEr.Arn-, xtat 19, was, on the 3d ofMay, admitted at the I-lotel-Dieu, under thecare of M. Husson. He had, for three days,been affected with violent headach, pains inthe limbs, sore throat, nausea, fever, and avarioloid eruption, though he had been’vac-cinated in his second year, and had had thesmall-pox afterwards. From the 3d to the10th, the fever increased, the tongue becamedry, and covered with a crust. Having at

this period exposed himself to cold, the

eruption was suddenly suppressed, the pus-tules dried up, or became of a violet colour,and general debility, with diarrhoea, came on.He was twice bled by leeches applied to theabdomen, but the typhoid state increased,delirium succeeded, and the looseness wasaccompanied by tenesmus. On the 18th, ascarlatinous eruption appeared on the backand chest, with difficult deglutition andhoarseness. The fever subsided a little,and the new eruption terminated in vesicles,but the debility, delirium, and diarrhoea

augmented; when, on the 27th, a sloughwas formed over the sacrum, and on the30th the left parotid began to swell. Dur-

ing all this time, nothing but mucilaginousremedies were administered; but anotherphysician having now taken charge of thepatient, bark, wine, and strong beef-teawere given. Fluctuation being felt in thetumour of the parotid, it was opened on the6th of June ; but the patient sank and diedon the 8th. On examination, the mucousmembrane of the intestinal canal was found

slightly inflamed; and the reporter of thecase seems very much inclined to ascribethe fatal event to the irrational treatmentof the physician who succeeded M. Husson.Although we cannot subscribe to this opi-nion, we cannot but consider it injuriousthat a patient should be passed from onephysician to another, which, our readers areperhaps aware, occurs in nearly all the

larger hospitals of Paris.

GANGRENOUS LARYNGITIS AND BRONCHITIS.

A labourer, 17 years old, had for sometime been affecled with a very troublesome

cough, when, after an excess in drinking,he was taken with shivering, fever, generaldebility, violent headach, sore throat, anddiarrhoea. Some leeches were applied to

the throat, and, on the 5th of April, thepa.tient was admitted at the Hotel-Dieu. Atthis period the heat was moderate, the skindry, the pulse very small and frequent, theabdomen somewhat tender, the tongue dryand red, the mouth and nose filled with mu.cus, the breath very fetid, the throat verypainful, and deglutition difficult. The ton.sils and soft palate were covered with a thick,white, greyish mass, the voice was hoarse,respiration difficult and stertorous, and a

thick mucus was expectorated; eight leecheswere applied to the epigasttium. On the6th, the smell of the breath was truly gan.grehous ; the countenance was very pate,and expressive of anxiety ; the pulse couldnot be felt, and the voice was hardlyaudible. Thirty leeches to the throat, andsinapisms to both arms, were ordered; butthe patient died on the same morning.On examination, the whole cavity of themouth was of a livid colour, and lined witha thick albuminous mass ; the tonsils wereswollen, and of a dark-red colour. Thewhole extent of the larynx, trachea, and thelarger bronchial divisions, were covered bya false membrane of a white colour, andgradually decreasing in thickness. The

upper part of the right lung was hepatised,and very firm ; the left lung was healthy.The mucous membrane of the stomach wasred, and, on the great curvature, beset withgranulations.—La Cliniqtte.

ABUSES IN ST. BARTHOLOMEW’S HOSPITALi

To the Editor of THE LANCET.SIR,—Since 1 last troubled you with someobservations on the abuses at St. Bartholo-

mew’s Hospital, various chang’es have takenplace, another winter-campaign has com-menced, new house-surgeons have bem

appointed, and sundry dressers installed intheir situations ; thus, as there is a greatersphere of action, so is there an adequateproportion of abuse : should you thereforethink fit to insert the occasional remarks, Ishall send you in the couise of the winter,it will still further prove that you are, what

you have ever been, the pupil’s friend.With respect to the demonstrations at

St. Bartholomew’s, they have been for thelast year or two, unquestionably the most

inferior in London ; and it would becomeMessrs. Abernethy and Stanley, if theyhave any regard for their own interest, andthe pupils’ welfare, to pay a little more at.tention to the qualifications of those whom