205

ANALECTA.

1. Aneurism of Arteria Innominata, treated by lying the Carotid. Mr. R. Gardner, aged 51, of sound constitution, about three years ago, while lifting heavy weights, was attacked with pain in the upper and back part of the neck. This continued for some months, and extended to the right shoulder and arm ; and about a year and a half ago, he discovered a small swelling at the upper part of the breast- bone, but did not observe any throbbing in it till some time afterwards. Upon examination, I found above the sternum a pulsating tumour, about the size of a pigeon's egg, spreading some distance under the clavicular and sternal portions of the right sterno-mastoideus muscle, in the course of the subclavian artery, and extending as low down upon the pleura as the second rib, compressing the bronchial tubes, and producing a wheezing, not unlike that of asthma. He shrunk from the least pressure upon it, complaining of impeded respiration and pain. Its pulsations were synchronous with those of the heart, and decidedly aneurismal. He was recommended to avoid all exertion, to be occasionally bled,

and to confine himself to a vegetable diet. After some time, as the disease was increasing, I determined upon tying the carotid artery, to observe the result, and afterwards to secure the subclavian, should it be required. On the 26th September, the artery was taken up in the usual manner. Next day he breathed freer, had slept well, and felt refreshed ; the pulse was 58, regular, the skin natural, and the pulsation and size of the tumour evidently diminished. Being habituated to laudanum, he was allowed a teaspoonful in the evening. On the 28th the breathing was easy, the pulse 63, and the pulsation in the tumour less. In the

evening, the pulse of the right radial artery was distinct, but intermit- ting; in the left arm, 80; coughs frequently, and expectorates freely. He was ordered calcined magnesia and Epsom salts. On the 29th, cough and expectoration much less, pulse 71, regular. The radial

artery of the right arm beating as yesterday, with fewer intermissions, but of longer continuance ; skin over the tumour more wrinkled ; pul- sation less and weaker. Continued to improve, and on the 15th

October the ligature came away. The tumour above the sternum, and pulsation, completely disappeared ; cough and breathing better; voice nearly natural; pulse 66 ; now and then a very faint pulsation of the right radial artery; right hand a little swelled and feels numb, and complains of the want of power to close it. In a few days he left town for his residence in New Jersey.?Abridged from American Journal of Med. Sciences. 2. Case of Poisoning by Arsenic and Laudanum combined, in which

the symptoms usually produced by Arsenic were absent.

On the 7th August, about 12 o'clock, Marianne Warwick swallowed three ounces of laudanum, and about two drachms of arsenic, and was seen by Mr. Jennings, who reports the case, soon after four. She had no pain in the stomach, bowels, or head; complained of no burn-

vol. iv.?no. 14. 2d

206 Analecta.

ing in tlie throat, or uneasiness in the abdomen when pressed upon ;

and she was perfectly collected. She complained, however, of being tired and sleepy, which she ascribed to the effects of an emetic which she had taken two hours before, which had operated violently. Her

eyes were blood-shot and heavy, and the pupils contracted. Pulse about 100. The stomach was freely evacuated, the contents being preserved for analysis. The usual medicines to counteract the effects of the laudanum, together with bleeding from the jugular vein, leeches, blisters, and cold affusion, were employed.* The patient was kept constantly walking about; she gradually became more drowsy; at

eight o'clock she sunk into a state of coma, and died before nine. Examination of the body 16 hours after death.?On removing the

dura mater, the parts presented a very turgid appearance, and the

large veins which wind between the convolutions of the brain, instead of presenting their ordinary blue tint, were of a dirty treacle colour. The pia mater was more than usually loaded with blood. On opening the cavity of the abdomen, the stomach appeared large,

and a few small vessels were evident in one or two places on its sur- face?but nothing that was calculated to attract attention presented itself. The stomach contained about half a pint of fluid ; its mucous coat was generally rather pale, but at the great arch, near the pylorus, there were two patches that presented a red appearance?the one the size of a half-crown, the other about as large as a shilling. There

was no ulceration. The mucous membrane of the duodenum pre- sented, throughout, a general light pink appearance. In the jejunum it was highly injected, and presented numerous patches of an intensely red colour. The appearances of inflammation were less marked in the

ilium, though several patches, acutely inflamed, were observed in it.

No ulceration of the small intestines could be detected. On analysis, the contents of the stomach exhibited a slight trace of

arsenic. Sulphuretted hydrogen gas gave the fluid a yellow tinge. The test with the nitrate of silver and ammonia threw down a very slight yellow precipitate. From the fluid contained in the small intes-

tines, a sufficient quantity of precipitate could he collected, to reduce the arsenic to its metallic state. The fluid vomited at half-past four, contained so much arsenic, that from one half of it many grains of the precipitates were collected, a large quantity of metallic arsenic reduced, and a very well-marked alloy formed with it and copper.?Abridged from Med. and Phys. Journal.

The symptoms in this case certainly do not present the usual train of phenomena observed in cases of poisoning by arsenic; and Mr- Jennings conjectures, that they may have been checked by the presence of opium. This we think very probable;?and if he had examined the contents of the stomach, or what was vomited, and detected the pre- sence of opium in these fluids, and none in the contents of the small intestines, in which there was a large quantity of arsenic, and on which the effects of the poison were evident, we should have believed

* A most extraordinary combination of remedial agents, certainly, in a case of poisoning by laudanum.?EE.

Analecta. 207

that the question had at least received all the elucidation of which it was susceptible.?EE.

3. Case of Death from inhaling Nitrous Ether Vapour. Elizabeth Stephens, servant, went to bed in perfect health, and was

found dead in the morning of the 31st March, lying on her right side, with the arms folded across the breast as in profound sleep, and the features not at all distorted. The following evidence given before the coroner's jury by the medical witnesses, will sufficiently explain the particulars of the case.

Richard Morton, surgeon, stated, that he, Mr. Hathway, and Mr. Henry Morton, opened the body of the deceased, and found the coat of the stomach a little inflamed, with a small quantity of fluid con- tained in it not exceeding an ounce; there did not appear to be any

gritty substance in the stomach; the intestines leading from the stomach appeared tinged. On farther examination, the uterus was found

enlarged, and its outer coat highly vascular. On being opened it was found to contain a male foetus, indicating that she had been three months gone in pregnancy. Witness farther stated, that he saw deceased soon after the body was discovered, and remarked, that a jar contain- ing upwards of three gallons of spirits of nitrous ether was broken, and the contents spilt about the room ; and the room being small, and the atmosphere being highly impregnated by the said spirit, witness was of opinion that it was sufficient to have caused the death of the

deceased. Mr. Henry Morton concurred with the first witness, as to the cause of the death of the deceased.

Mr. Nicholas Hathway, surgeon, concurred with the previous witnesses in his description of the appearances on dissection. He enter- tained the same opinion as to the cause of death, and added, that the lungs were found in such a high state of confusion, a9 to prevent the passage of the air through their cells. The witness could not account tor the inflamed state of the stomach. The verdict of the jury was in accordance with the deposition of the medical witnesses.?Abridged from Midland Medical Reporter.

We fancy every one who reads the above particulars will regret that the examination of the body was confined to ascertaining the state of the stomach and lungs. Dr. Schwk, medical inspector of Siegen, who reports two cases of death caused by the vapours of burning wood, notices paleness of the countenance as a singular accompaniment of cerebral congestion, and he calls the attention of medical jurists to the extreme calmness of the features, as a general character of this variety of poisoning. The lungs, too, in all these cases are distended with black fluid blood; and in addition to this, Portal says, that

the vessels of the brain are gorged, and the ventricles contain

serum. Both Wildberg and llitzdorff have related cases of death from suffocation by noxious vapours, in which all the morbid appear- ances mentioned above were conspicuous. But in addition to the imperfection of the anatomical inspection, the state of the stomach, and the existence of a fmtus in the uterus, were circumstances, in

themselves, which called for a far more particular examination than

208 Analecta.

apparently took place. We blame the individuals who conducted this examination, less than the imperfect system of medical education in this country, which does not insist upon an acquaintance with medical jurisprudence as an essential part of the acquirements of a physician.? EE.

4. Paralysis of one-half of the Body without loss of motion. M. Loriot, aged 73, previously healthy, suddenly experienced a

numbness in the left inferior extremity, which soon extended over the whole left side of the body. Next day he was in the following state :

Intellectual faculties unimpaired; pulse unaffected; he could walk and move his arms as usual, except that the elevation of the arm was somewhat limited. He was not conscious of the movements he exe-

cuted, nor of the impressions of the bodies he touched. The skin of the left side was perfectly insensible; it was pinched and pricked violently without producing pain, or even sensation. Anteriorly the median line was not the exact limit of sensation, for on the left side the skin was still easily sensitive to the extent of about an inch from the central division, beyond which it was perfectly insensible on the affected side ; the sense of sight and hearing remained, but smell and taste were abolished. If the left side of the tongue was moistened with strong vinegar, the patient was unconscious of the slightest impression, but the flavour of the liquid was keenly perceived by the other half of the organ. Strong odours placed under the nostril of the affected side were not perceived. When a hand was placed across the patient's head, only that part of it was felt, which pressed upon the right half. Every treatment that was suggested was ineffectual. A

few months after the attack M. L. had resumed his ordinary occupa- tions. For some time he felt occasionally dull pains on the hemiplegic side. He could move the limbs on that side without difficulty, but the movements were inferior in degree to those of the other side. In other respects his constitution had not suffered.?Bull, des

Sciences Medical.

5. Remarks upon the application of Ligatures to the Penis, after the method of M. Grcefe. By M. Mich^elis, of Berlin.

Towards the close of the 17th century, Ruysch and other surgeons adopted the practice of applying ligatures to the penis, but latterly this operation has been neglected.

In 1815, M. Groefe revived it. M. Michselis records four cases, which appear to be in favour of the practice. The subject of the first operation was a man twenty-nine years old, who had contracted, from impure connexion, a venereal ulcer upon the glans penis. The ulcer

yielded to a course of mercury, but returned in a few months, and then resisted every plan of treatment. It rapidly increased in extent, and sometimes bled very profusely. In about a year after the patient had been first diseased, it was deemed necessary to remove the penis: he was taken to Berlin, to be operated upon by Grajfe. A catheter was introduced into the urethra, and then, with a strong ligature, the penis was strangulated immediately behind the glans. The

patient bore the operation with great sang froid, and without appear-

Analecta. 209

ing to suffer the least pain. No fever followed. In the evening of the Bame clay the part beyond the ligature was deprived of vitality, and the ligature was tightened without any inconvenience to the patient. On the second day the dead part was detached, and the catheter was withdrawn. The cure proceeded so rapidly, that in one month the patient quitted Berlin.

Case 2. Half the penis was cancerous. The operation was per- formed as in the last case: but little pain was complained of. In

twenty-four hours the sphacelated part was removed, and the cure proceeded favourably, being interrupted only for a short time by an attack of intermittent fever, which occurred the third day after the operation.

Case 3. After an old venereal disease, cancer of the penis occur- red. The patient felt perfectly well after the operation. No fever

followed, and the wound rapidly healed. Ten days after the operation the man quitted Berlin.

Case 4. A man, sixty years of age, was affected with cancer of

nearly the whole of the penis. The disease had arisen about a year after several ulcerations, which had appeared upon the glans without any known cause, and which, by uniting, had formed one vast ulcer, which extended to near the pubis. In applying the ligature it was necessary to draw the penis firmly forwards, in order that no diseased part might remain. Fifteen days after the operation the patient had per- fectly recovered.?Journ. der Cliir.

6. Guys Hospital.?Removal of a Tumour fifty-six pounds in weight, extending from beneath the Umbilicus to the anterior border of the Anus.

Hoo Loo, a Chinese labourer, was admitted into Luke's

ward, Guy's Hospital, in the third week of March last, with an extraordinary tumour depending from the lower part of the abdo- men, and of a nature and extent hitherto unseen in this country. He had been brought to England from Canton, by his own desire, in an East Indiaman, for the purpose of having this tumour removed at one of the London hospitals, the native surgeons declining to make the attempt, a general disinclination to the performance of serious operations prevailing in the East, where both the climate and the law offer important objections to surgical proceedings which may lead to the loss of human life. The case excited considerable interest both in and out of the profession, from the first moment of his arrival, and he was visited in the hospital by a great number of persons of all ranks. We have heard that on his voyage here, the change of air had such

an effect on his constitution, as to occasion a material increase in the tumour. Since his arrival, his appetite, health, and spirits, were extremely good. While in the hospital there appeared nothing to induce the surgeon to order him any medicine. His diet consisted

principally of boiled rice, and no restraint was placed on his appetite, which was very great. He was generally considered to have improved in health while in the hospital, though itwas difficult to form a decided

210 Analecta.

estimate on this point. He all along contemplated the operation with satisfaction.

It was generally understood that the operation would be performed on Tuesday last, but so great a crowd of spectators was apprehended, that Saturday, which is a dies non in the hospital, was fixed on in- stead. Notwithstanding this precaution, however, an assemblage, unprecedented in numbers on such an occasion, presented them- selves for admission at the operating theatre, which was instantly filled in every part, although none but pupils, and of those only such as could at the moment present their

" hospital tickets," were admitted. Hundreds of gentlemen were consequently excluded, and it became obvious to the officers of the hospital, that some other room must be selected. Accordingly Sir Astley Cooper entered, and, addressing the pupils, said, that in consequence of the crowd, the patient being in a state which would admit of the removal, the operation would take place in the great anatomical theatre. A

tremendous rush to that theatre accordingly took place, where accommodation was afforded to 680 persons, and where preparations were immediately made for the patient. In about a quarter of an hour, Hoo Loo entered, accompanied by two nurses and a posse comitatus, consisting of various functionaries of the hospital, and in the course of a few minutes he was secured on the operating table. A short consultation now took place between Sir Astley Cooper, Mr. Key, and Mr. Callaway, during which it was finally agreed, that if it were found possible, the genital organs should be preserved. The face of the patient was then covered, and Mr. Key, taking his station in front of the tumour, commenced the operation. His

object, apparently, was to make three flaps, of such a form and

extent, as would cover the penis and the testes when they should be relieved from the tumour. The first flap was made on the ante- rior part of the tumour ; the others on either side. The former of these would have covered the penis, and the two others (which were made semilunar in figure with the convexities looking outwards,) would have accomplished the purpose, when united, of enveloping the testes, and at the same time of forming the integument of the perineum. The first incision was commenced on the right side, just under the abdominal ring, and being carried obliquely inwards for about an inch, was continued so as to form the semilunar cut, from the lowermost point of which, the knife was again carried in- wards, in order, apparently, to leave such a small projection of in- tegument as, with a corresponding piece on the opposite side, might serve to go round the root of the penis. This portion having been reserved, the incision was continued onwards for about four inches in a straight line, and was then turned at a right angle, parallel with the operator, forming a line of about two and a half inches in length. A similar cut was then made on the left side, and con- nected with that on the right by the parallel or transverse cut. The flap thus formed was now dissected from the tumour, and laid back upon the abdomen. The operator then proceeded to lay bare the two cords and the penis, a step in the operation which was per-

Analecta. 211

formed with very great neatness. Sufficient time had now elapsed for the depressing effects of the operation to exhibit themselves, while the penis and testicles had yet to be dissected out. The determination to attempt this arose from its having been ascertained that the sexual inclinations of the man were unimpaired, seminal emissions being occasionally experienced. The delay, however, which so intricate a portion of the operation would have occasioned, now induced Sir Astley Cooper to propose, that the genital organs should be sacrificed, and the suggestion was promptly acceded to. A temporary ligature was accordingly passed round each of the cords and the penis, and these being divided, the remainder of the operation was pursued solely with a view to the removal of the

whole mass. But a period of time elapsed before the conclusion of the operation, which must have far exceeded the anticipations even of the most fearful, and by the time the tumour was entirely sepa- rated and the exposed parts were closed over, an hour and forty- four minutes had passed. This tremendous protraction was chiefly occasioned by the intervals which were from time to time allowed the patient for recovery from the fits of exhaustion which supervened. Complete syncope occurred twice, and during the whole of the lat- ter steps of the operation he was in a state of fainting. The quan- tity of blood lost was variously estimated by those who assisted, and though certainly not large, it was the operator's own impression, that the haemorrhage was the immediate cause of death. It would

probably be correct to state the loss at twenty-five ounces, although as few as 14 and as many as 30 were named. Of this quantity not more, we should think, than a single ounce was arterial; all the

ligatures were quickly applied, and with great dexterity. The

number of large veins divided was immense, but only three small arteries, besides the two spermatic, were taken up. Immediately after the removal of the tumour, another fit of syncope?if syncope could be said to be at all incomplete for the last half hour?came on, from which the poor fellow did not for a moment rally. No remedies that were directed to overcome this state of collapse had the slightest effect; warmth and friction of the extremities, warmth to the scrobiculis cordis, the injection of brandy and water into the stomach, and, ultimately, from the suspicion that the loss of blood had been too great, transfusion to the amount of six ounces, taken from the arm of a student?one amongst several who offered to afford blood?were amongst the means resorted to. The heart's action

gradually atid perceptibly sunk. The patient did breathe after the operation, but that is as much as can be said. Artificial respiration was subsequently, but vainly attempted.

The fortitude with which this great operation was approached, and throughout undergone, by Hoo Loo, was, if not unexampled, at all

events never exceeded in the annals of surgery. A groan now and

then escaped him, and now and then a slight exclamation, and we thought we could trace in his tones a plaintive acknowledgment of the hopelessness of his case. Expressions of regret, too, that he had not rather borne with his affliction than suffered the operation, seemed

212 Analecta.

softly but rapidly to vibrate from bis lips as be closed bis eyes, firmly set his teeth, and resignedly strung every nerve in obedience to the determination with which he had first submitted to the knife.

His character was naturally exceedingly amiable. When occupied in thought, bis features assumed an appearance of slight melancholy, but at other times a very cheerful and good tempered expression of countenance prevailed. The appearance of the features after death was very characteristic of this. Whenever an exhibition of the tumour was desired, he was displeased and somewhat reluctant, seeming to imply by his language, that it was of " no use" to show it. With the

nurses he had become a great favourite, and his death elicited the

utmost commiseration, perhaps a few tears, in the ward which lie

inhabited. Hoo Loo was 32 years of age, and the tumour had been ten years

arriving at its present growth. Its effect upon his frame, and the mus- cles of the abdomen, was not particularly oppressive. It of course

occasioned a very great strain upon the fore part of the body, and to preserve his balance he was compelled to throw the shoulders back- ward, and assume the gait of an alderman, whose belly preponderates and displaces his centre of gravity. The weight of the tumour was conjectured to be about seventy pounds, but when placed in the scales after its removal, it weighed but fifty-six. His strength was not

affected by it. He could take a stout lad in his arms, and toss him with ease.

The tumour commenced in the prepuce; the cause of it is involved in obscurity; nothing could be gathered from the patient to lead

to the supposition that it was the effect of a blow, or to justify its being ascribed to any one particular exciting cause. Its form inclined to that of a flattened spheroid. When removed, and resting either upon its upper surfaces or its base, it sunk and spread until its

mean depth was about six inches. The neck or peduncle by which it was attached was of a triangular form ; the upper and anterior side of the neck was parallel with the os pubis, extending on each side of the external abdominal ring about two inches and a half, its other sides occupying the lateral boundaries of the perineum, and

meeting in an acute angle immediately before the anus. Although the disease commenced in the prepuce, that portion of the tumour, or an elongation of it, was preserved in an isolated state from the

rest of the growth, although of course totally disfigured, and pre- senting far greater appearance of disease than other parts of the in- tegument. It now hung at the lowermost portion of the tumour, forming a second tumour, presenting an orifice for the discharge of the urine, varying in its transverse diameters from one to three inches. The passage to the urethra was, as far as the finger could reach, smooth and hardened ; externally it was a mass of tubercles, which spread on each side over the surrounding portion of the tumour, presenting for a considerable distance a hard and thickened cutis, studded with ele- vations. The sides and posterior part of the body of the tumour, as well as the whole of the peduncle, were of a perfectly healthy and natural appearance. The circumference of the mass was four feet,

Analecta. 213

that of the neck two feet, each side of the neck, which was about equi- lateral, measuring eight inches. When the patient stood upright, the! lower part of the tumour reached considerably below the knees.

It may be mentioned, that the urine also found a vent externally by an opening situated on the surface of the tumonr immediately at the base of the preputial tumour, which latter, as it had a strong ten- dency to overlap on the side of the opening, hid the false passage, if it may be so called, from sight.

Post-mortem examination.?The examination of the body took place on Thursday morning.

From the tumour itself a certain quantity of fluid (not large) es- caped during the operation ; the solid mass weighed fifty-six pounds, as we have already mentioned. It was decidedly steatomatous ; but the examination has not yet been completed. About an inch of the

penis was laid bare by the dissection. There were no appearances which arrested the attention on the ex-

amination of the body. The stomach and other viscera were perfectly healthy. The cremaster muscles were both much increased, apparently from an enlargement of the fibres, and not from any multiplication of them. The state of the wound was not at all unnatural; but, somo of the veins which came from the tumour were as large as the little finger. The arteries of the chord were not larger than usual.?Lancet.

7. On a New and Simple Mode of Operation for Nccvus. By Marshall IIall, M.D.

The danger of hsemorrhagy from the excision?the excessive pain of the ligature?and the extensive scar left by vaccination, as these have been respectively employed for the cure of njevus, induced me to consider whether some less objectionable mode of operation in these cases might be devised.

About nine months ago I was afforded the opportunity of examin- ing a case of this kind, and of superintending the operation, by my valued friend, Mr. Heming, of Kentish Town.

This operation consisted in introducing a couching needle with cut- ting edges, at one point of the circumference of the nsevus, close by the adjoining healthy skin ; from this point the instrument was made to pass through the tumour in eight or ten different directions, so as to produce slight incisions through its textures, parallel with the skin, but not so as to pierce the tumour in any other part. The first point of puncture was made the centre of the several rays of slight incisions effected by merely withdrawing, and again pushing forward, the little instrument in the manner and in the various directions, just described.

The naivus was oval, and rather larger than a shilling; the couch- ing needle was introduced at one point, passed as nearly as possible to the opposite edge of the tumour, without piercing it, and then in vari- ous directions, until eight or nine punctures, or rather incisions, tra- versing the texture of the tumour, but not the skin, had been made. A little pressure was then applied over the tumour, by means of strips ?f adhesive plaster. There was no pain, and of course no haemorr- hagy, and as the skin was only punctured in one point, there could Result no scar.

vol. iv.?no. 14. 2 E

214 Analecta.

I expected that inflammation would take place, and that a cicatrix would be formed, which from its solid texture and progressive con- traction, would obliterate the textures of the tumour.

For some time?for several weeks?little appeared to have been effected. There was little or no change in the appearance of the

nsevus of any kind. Indeed it was almost concluded that the plan had failed?that the vitality of the part had been too low to yield the de- gree of inflammation required for the cure. What a short time did not effect, however, a longer period accomplished

completely. Half a year after the operation the tumour was found to have disappeared, and the colour of the skin to be nearly natural: the skin itself was perfectly preserved, free from any appearance of scar. To obviate the occurrence of haimorrhagy, of pain, and of scar, is

of sufficient importance, in itself, to attract the attention of surgeons in the treatment of this affection. But, besides this consideration, ntevus sometimes occurs in situations, as in the tongue, the eye-lids, &c. not admitting of any other mode of operation. It does not appear that pressure forms any necessary part of the treatment. The cure in the case detailed was gradually effected, long after pressure had ceased to be employed?Med. Gazette. 8. Thirty-sixth Annual Report of the Glasgow Royal Infirmary. LIST OF PATIENTS ADMITTED AND DISMISSED FROM 3IST DECEMBER, 1829, TILL

31ST DECEMBER, 1830, INCLUSIVE. Patients in the House 31st December, 1829, - 221 Admitted during the year, ------ 2010

Total, - - 2231

Disposed of, ------- 2010

Remaining Slst December, 1830, ----- 221 2231

Medical, - 1313") onin Males, - - 1169") oniO Surgical, - 698 J Females, - - 841J

~

Cured, - - 1577 Brought forward, 1791 Relieved, - 9S Improper, - 7

Improved, - 7 Incurable, - - 10

Convalescent, - 8 Remitted, - 10 Advice, - 40 Died, - - 192 Dismissed by desire, 33 2010 Irregular, - 28 Remaining in the House, 221

Carry forward, 1791 2231

LIST OF DISEASES TREATED IN THE INFIRMARY IN 1830, WITH THE NUMBER OF DEATHS FROM EACH.

Abortion, Abscess, common, -

Lumbar, -

Psoas, Perinseal, -

Strumous, - of Liver, -

Amenorrhea, -

Aneurismal Varix, -

Angina Pectoris, Angina Laryngea, -

i Carry forward,

Brought forward, Anus, Artificial, Anomalous, - - -

Apoplexy, -

Asthma, - - - -

Bladder, diseased, -

Bloody Urine, - Bruise, - - -

Burn, -

Bursa, diseased, Carbuncle, -

Carry forward,

Analecta. 215

Brought forward, Caries, - - - -

Catarrh, - - - -

Colic, -

Concussion of Brain, Consumption, Costiveness, - -

Cramp of Stomach, Cutaneous Affections,

Ecthyma, Erythema, Eczema, Elephantiasis, Herpes, Lepra, -

Lupus, -

Nsevus, -

Porrigo, Prurigo, Psora, - - -

Psoriasis, Purpura, Scabies, Sibbens, Not defined, -

Deafness, -

Diarrhoea, - - -

Diabetes Mellitus, -

Insipidus, Dislocation, simple, -

compound, Dropsy, general,

of Belly, -

Chest, -

Scrotum, Pericardium,

Dysentery, acute, chronic, -

Dysury, - - -

Emphysema of Lungs, Epilepsy, Erysipelas, Eye, diseases of Exostosis, Fever, continued,

Intermittent, Fracture, Compound, of -

extremities, ? of Jaw, - ? Simple? ? of Bones of Face, ? Extremities,

Clavicle, -

? Neck of Femur, . of Scapula, ? Spine, ? Ilium, Ribs,

Fistula in Ano, ? recto-vaginal,

vesico-vaginal, Fungus, -

hicmatodes, -

Gangrene, -

Carry forward,

1

2 14 16

1

729 7

U

1

65

10 5 3 1 2 7 6 1 1

2 1

_3_2 J 2051:38

81

Brought forward, Glands, enlarged, Gonorrhoea, -

Harelip, -

Headach, - - -

Head, affection of, Heart, organic disease of, - Hypochondriasm, Hysteria, -

Indigestion, -

Inflammation, of Bowels, Bronchi,

Cellular of Kidney, - ? Liver,

Lungs, ? Pericardium,

Periosteum, Inflammation, of Peritoneum,

? Pleura, ? Synovial

Membranes, ? Spleen, ? Stomach, ?? Testicle,

Womb, Injuries, -

Jaundice, - Joints, diseased, Leucorrhcea, -

Lumbago, Morbus Coxarius, -

Menorrhagia, -

Nymphae, enlarged, - Necrosis, - Palpitation, Palsy, Paraph ymosis, - Piles, Pleurodynia, Poison, effects of, Polypus in Nostril, - Prolapse of Womb, -

Prostate Gland, diseased, Phymosis, Congenital, Purpura, Pyrosis, Rheumatism, Rupture,strangulated Femoral,

Inguinal, Omental, St. Vitus's Dance, -

Scald, Sciatica, - - - -

Sarcocele, - - -

Scirrlius and Cancer,, Scrofula, -

Skull, fracture of, -

Small Pox, -

Spine, diseased, Spinal Irritation, Sprain, - - - -

Stone in Bladder, Stricture of Rectum,

of Urethra,

Carry forward,

1265

2

1738

216 Analecta.

Brought forward, Syphilis, - - -

Speech, impediment of, -

Tabes Mesenterica, -

Tetanus, - Thrombus, -

Tic Douloureux, Tumour, -

Irritable mammary, Tormina, - ?

Tympany, -

Ulcer, common, Herpetic,

? Sinous, -

Varicose,

Carry forward,

1788 45

1

1 3 1

2 25 3 ]

1

120 1

5 3

Brought forward, Ulceration of Intestines, - Urine, incontinence of Uterus, diseased, Varicose Veins, Vesical Catarrh, Vomiting of Blood, - Warts, -

Wen, Wound, common, -

of Throat, -

Lacerated, Punctured, Incised,

Whitlow,

LIST OF OPERATIONS FROM JAN. 1., 1330, TILL JAN. 1., 1831.

21 of the undermentioned remain still in the House under treatment.

Amputation of Arm above elbow* 4

Fingers at various

Joints 13 ? Forearm below elbow* 5

? Leg below knee* 4 ?????? Metacarpus, portion

of - 1 ??? Tarsus, Chopart's

operation - 1

1 Thigh above ltnee* ]] Thumb 2 Toes at various joints 2

Artery Humeral, Ligature of, at

bend of Arm - 1

Artery, Subclavian, Ligature of, above Clavicle - - 1

Artificial Anus, Dupuytren's opera- tion for, ------ 1

Extirpation of'Lip, Cancer - 6 ? -Mamma - - 7

-Naevus and Aneuris- mal Varix . 5

Extirpation of Polypus, (nasi) 4 Tumour 12

Extraction of Cataract - 2 Fistula in Ano, incised - - 12 Fistula Lachrymalis - 2 Hernia, Femoral, Strangulated

Scrotal Omental, Strangu- lated -

Humerus, ununited Fracture of, Seton passed through

Dislocation of, into Ax- illa, reduced

Hydrocele, punctured or injected 20

f Lithoplatomy in Female f Lithotomy in Male Fhymosis, Congenital, incised f Urethra, Calculus extracted from, by incision

Total, 129

N. B. The above eight cases of Stone in bladder and urethra operated on, have all recovered. They are marked thusf.

The Treasurer in .Account with the Glasgow Royal Infirmary, Dec. 31, 1830. Charge,

To Balance of.Cash from Mr. M'Lean , ? L 23 3 2

To do. do. in Thistle Bank - .347 16 6 L. 370 19 8

To Annual Subscriptions - - - 3089 3 5

To Extraordinary Receipts, Legacies, &c. 1335 0 3

To Donations, including L.26 : 0 : 6d. for Fever

Hospital - - - - 224 10 6 To Apothecary, for Tickets, Diplomas, Clerks'

Board, &c.f. - - - - - 1052 1 2 To Interest from Sundry - 576 7 3 To Rents from Sundry - - .97.10 0

Income for the year - - - 6374 12 7

I T / L. 6745 12 3

* We consider the words in Italics superfluous.?^EE. f Including upwards of L.200 of students' fees, due the present medical attend-

ants for clinical lectures.

Analecta. 2 IT

Discharge. By Ordinary Expenditure, Provisions, Salaries,

Wages, &c. - - - - L. 2932 8 3 15y Medical Expenditure, Medicines, Salaries,

Wines, &c.* ______ ]452 jg 6 By Repairs and Furniture - 363 3 8

By Incidental Charges, Printing, Stationery, &c. 402 4 10 By Mr. Thomson's Legatees - .25 0 0

Expense for the year - - - 5175 9 3 JBy Balauce in Thistle Bank, 31st Dec.

1830 L. 1453 2 3 By Balance in Treasurer's hand 17 0 9

1470 3 0

By this Sum additional Bonded during the year - - - - - - 100 0 0

Amount of Income, as above L. 6374 12 7 Do. of Expenses, as above 5175 9 3

*

Increase - L. 1199 3 4f

L. 6745 12 3

It was resolved by the Managers of the Infirmary for 1826, that, " for obvious reasons, it becomes highly desirable that as much light as possible be thrown on the nature, localities, usual progress, and ter-

mination, of the Diseases received into the Infirmary, from Glasgow, and the wide district around, so that materials be annually furnished for a Medical, and Statistical History, or Medical and Statistical Tables, of the State of Health, and Disease, in the said City, and District."

With this view, certain regulations were adopted?regulations cal- culated to produce the desired result, but unfortunately no permanent officer connected with the institution was appointed to carry them into effect, and no fixed model for the statement was adopted.

The elections of Managers and Medical Attendants in this

Hospital are annual, and, on the whole, perhaps, it is as well for the

general interests of the institution that they are so. But it cannot be

denied, that much valuable information is lost from this cause, and likewise that the regulations of former Directors are overlooked or altered by their successors in office. It is quite obvious, that no

important statistical results can be ascertained from the reports of the Infirmary till these are drawn up annually for a series of years by the same individual, and on one uniform plan. These last remarks are

applicable only to the medical and surgical departments, and do not refer, in the least, to the general report as to the funds and other

unprofessional matters. We conceive, that a medical report of the Hospital on one uniform

plan, would ultimately be a most valuable document to the medical man and the statist, and we cherish the hope, that the Managers of the Hospital will, sooner or later, appoint a medical officer to carry the suggestions of their predecessors in office into full effect.

These remarks have been elicited by the perusal of the list of oper- * Including L.206 : 17. paid the medical men for clinical lectures, during

session 1829-30. The amount of clinical fees should form no part of the income or expenditure of the Infirmary, as, by doing so, the average cost of each patient, is apparently greater than it really is.

f Infirmary Report for 1830, just published.

218 Analecta.

ations for this year, as stated in the foregoing table. It is there stated, that during the year, one hundred and twenty-nine operations have been performed from 1st January 1830 to 1st January 1831, and that twenty-one of the patients operated on still remain under treatment in the house. This table is constructed on different principles from any former one, and diminishes the value of the Infirmary reports. We

shall show in what manner it does so. Previously, the medical part of the report stated the results of the cases only. The lists of diseases and operations were compiled from the dismissals, and, of course, the result of every case was known before it was introduced into the state- ment. In all the previous tables of operations only those performed on patients dismissed were introduced ; in this one, twenty-one patients are mentioned as still under treatment, and nine deaths are stated as the result of these 129 operations. But some of those under treat-

ment at the close of the year may die, and thus materially affect the proportion of cures, and, indeed, the death of one of them is stated in the last No. of our Journal, in Dr. Perry's report. Besides, by taking into the table only the operations performed during the year 1830, all those performed in the close of 1829, and still in the house on 1st

January 1830, never appear in any Infirmary report at all, and thus impair the results to be drawn from them. Another objection is, that in constructing the table for 1831, if it is .done on the plan uniformly adopted previously to 1830, viz. from the dismissals, the twenty-one patients under treatment on 1st January 1831, will be again included, and thus an apparent increase of operations, leading to erroneous con- clusions.

In former reports, the operations performed on patients admitted into the Infirmary were alone inserted, and those on out-patients merely noticed in the body of the report. In the present table, some

operations performed on persons never admitted into the Infirmary have been inserted. For example, we find in the table of diseases treated in the Infirmary, six patients with fistula in ano, and 13 with hydrocele ; and, in the list of operations, 12 for fistula in ano, and 20 for hydrocele, and, to medical men at a distance, the inference would be, that the operations had been twice performed on many of the

patients, the first attempts having failed. We have made up the following table of operations as accurately

as we could from the information afforded to us by the surgeons, and have arranged the operations as in our last report, stating the deaths from each operation.

In this table, which is compiled from the dismissals, the twenty-one patients above-mentioned are excluded, and those operated on the latter end of 1829, and dismissed after 1st January, 1830, are

included.?The operations for hydrocele, and fistula in ano, are

reduced to the number of patients actually admitted with these dis- eases, and the reduction of a dislocation omitted, on account of the number of patients admitted with dislocations being 7, and only one reduction mentioned in the table, while we have reason to believe that all were reduced, except one of the shoulder joint of six weeks standing.

Analecta.

LIST OF OPERATIONS, EXHIBITING THE DEATHS AFTER EACH.

Amputations after Accidents. Primary? Thigh Forearm -

Metacarpus, portion of Thumb ?

Fingers -

Secondary? Thigh ...

Leg -

Arm - - -

Thumb - - -

Amputations for Diseased Bones, $c. ?-c.

Thigh Teg -

Toes -

Arm - - - -

Forearm, - - -

Fingers Artery, subclavian, ligature

of, above clavicle Artificial anus, Dupuytren's

operation for - 0

Carry forward, 41 34 6

Brought forward, Extirpation of cancerous

breast -

Extirpation of Nrevus and Aneurism by Anastomo- sis -

-Polypus (nasi) Tumour

Extraction ot Cataract Fistula in ano

Lachrymalis ( one patient) _

Hernia, Femoral, strangu- lated

Scrotal omental do. Humerus, ununited, fracture

of, seton passed through Hydrocele -

Lithoplatomy in female Lithotomy in male Phymosis, congenital, inci-

sed -

Urethra, calculus extracted from, by incision

It appears from the Infirmary report, that the number of patients for the year is reduced below what it was last year. In 1828 the number treated in the house was 3133, of which were fever cases 1500 In 1829 do. do. do. 2320 do. do. 858

In 1830 do. do. do. 2010 do. do. 729

This statement is satisfactory, showing the diminished prevalence of disease, particularly of fever, the existence of which is, at all times, the index of increased poverty and deprivation among the lower classes of the population.

The decrease in the number of patients this year is 310, being 205 in the medical, and 105 in the surgical department.

The patients of all classes treated during the year have amounted to 2010, and the deaths to 192, being a mortality of one in 10*46,

nearly the same proportion as last year. The deaths among the medical cases, exclusive of fevers, are 1 in

7*77 depending on the hopeless nature of the disease for which the patients were admitted, and which were in general dependent on such extensive morbid alteration of structure as to preclude the slightest chance of recovery. A glance at the list of diseases will prove the truth of this assertion. The proportion of deaths in the medical wards is rather more this year than last. In a city like Glasgow there are always numerous cases of incurable chronic disease admitted into the Infirmary, and in proportion as the town is healthy and the number of slight medical cases is diminished, in equal proportion is the rate of

mortality in the medical wards increased. The fever patients amount to 729, and the deaths to 81, being a

mortality of 1 in 9.

220 Analecla.

The deaths in the eurgical wards were 36, beinga mortality of 1 in 19-38. The surgical patients are usually healthy people, in the prime of

life, who are compelled to enter the hospital on account of accidents received in their various employments in the mines and manufactories in the city and neighbourhood, and present a striking contrast to the class of patients admitted into the medical wards, devoted to the

reception of chronic cases of disease. In proof of this assertion it may be stated, that out of 129 patients, admitted with ulcers, not a single death occurred; and of 268, received on account of accidents of various kinds, many of them very severe, only twenty died?ten of which were from fractures, and three of the ten after amputation. Fractures of the extremities formed fully l-6th of the surgical patients. In the list of diseases, three patients are stated to have had tetanus; this, however, does not mark the whole number affected with this incurable malady, the others having been classed under the accident which gave rise to it. Five patients died of tetanus: in one female

it supervened on amputation of the breast, for cancer?in a boy, it arose from a scald?in three men, from lacerated wounds; and it may be noticed, that the last four cases all occurred in the same ward.

The operations, as recorded in the second table, amount to 103, the cures to 93, and the deaths to 9. The patient who had the subclavian artery tied for haemorrhage,

after amputation of the arm, is included under the deaths from second- ary amputation, thus accounting for the discrepancy in the figures. The amputations amount to 39, the cures to 33, and the deaths to 6.

All the primary amputations succeeded. There were 4 deaths after 7 secondary amputations. Fourteen amputations (exclusive of fingers,) were performed for

diseased joints or bones, and of these only two patients died?one man, who had his thigh amputated, died of purulent depositions in his knee joint?another of consumption fully two months after amputation of the arm, and after the stump had Healed. A female died of tetanus, after the removal of a cancerous breast, and two patients after the

operation of hernia; all the other operations (with the exception of that for ununited fracture of the humerus,) terminated successfully, among which are to be noticed 5 of lithotomy in the male, and 1 of extraction of calculus, hy dilatation, from the bladder, in a female-

Medical and surgical clinical lectures have been delivered during the winter, in conformity with the regulations laid down by the

managers of 1829.?The number of pupils is annually increasing, and the terms on which they are admitted to witness the practice of the hospital, are more liberal than in any other institution in Great Britain.

The fee for two years' attendance in the hospital is ?6 6s., and for this sum the student is entitled to one course of medical and one of

surgical clinical lectures. The funds of the institution are in a flourishing state, and will con-

tinue to be so, as long as the establishment possesses the confidence of the public.

Edward Khull, Printer, Glasgow.