restored, which the ordinary nutriment of the body has been rendered incapable of supporting.

I am, Gentlemen,
Your very obedient servant,

R. UVEDALE WEST.

Jan. 18th, 1832.

Hospital Reports.

ST. BARTHOLOMEW'S HOSPITAL.

Case of Strangulated Inguinal Hernia, in a Patient labouring under Chronic Arachnitis.On the morning of the 22d January, about five o'clock, Henry Taylor, æt. 45, was brought to this Hospital, when it was found, after the usual examination, that he was affected with inguinal hernia. The tumour was exceedingly tenseindeed so much so as to preclude all hope of reduction by the taxis. The usual means, of course, were employed for that purpose; the warm bath, venesection, ice, and tobacco glysters. Mr. Lawrence saw the patient at an early hour, and deeming the operation to be indispensable, he recommended the patient to permit it to be done without delay. But the latter refused, observing, that when a similar tumour appeared in the same place before, he was fully able to reduce it himself. At half past twelve o'clock, Mr. Lawrence visited the ward again, and finding that pain began to be felt about the lower part of the abdomen, he urged the immediate performance of the operation, and succeeded.

After the sac had been cut into, the convolution of small intestine which presented, might measure from five to seven inches. Its appearance was generally of a favourable nature, except that it was somewhat preternaturally reddened. In consequence of the employment of a very small and shallow director, which proved quite insufficient for the necessary degree of protection to the surrounding parts,

the division of the stricture was attended by a wound of the intestine. A yellowish watery fluid flowed out, resembling the morbid secretion from the serous membrane of the abdomen, and might be easily accounted for by referring to the state of irritation produced by the hernia; but the secretion, as afterwards appeared, came from the mucous membrane of the intestines. A ligature was tied round the wound, and the intestine was returned to the abdomen. After its disappearance, the operator seemed surprized at finding behind the situation of the protruded intestine, a large mass of omentum, which was attached by very firm adhesions to the posterior surface of the sac. The ordinary state of entero-epiplocele isthe omentum anterior to the bowel; and Mr. Lawrence had no recollection of having met with such a case as this before. A considerable portion of the omentum was removed; and the vessels being very large, gave out a copious discharge of blood, and a considerable number were tied. The patient was then put to bed, and allowed to remain quiet for two or three hours, after which he took compound colocynth pill and sulphate of magnesia, at repeated intervals; but without effect. The pain in the abdomen increased in the course of the evening ; Leeches were applied in abundance, and purgatives repeated, but no motion, except the watery secretion already mentioned, followed. Next morning, he complained of great weakness; the pulse was low, and the surface of the body rather cold. Cordials and stimulants were employed without effect, and the patient died about one o'clock in the afternoon of the 23d, just twenty-four hours after the operation.

Autopsic Examination.-The appearance of the membrane lining the cavity of the abdomen was generally healthy, but on the side where the hernia occurred there was a slight increase of redness on the convolution of the intestines. The state of

rence at once observed that this relation of the intestines and omentum could not possibly have subsisted from the commencement of the adhesion of the latter to the back of the sac, and that the tense state of the omentum, which was so conspicuous, must be of recent production, and could only be ascribed to the sudden distention of the bowels. The result of the pressure was curious: the colon, at the point of its attachment to the omentum, was constricted, and so reduced in its diameter as to oppose an impediment to the passage of the fæcal matter. The convolution of intestine which had been protruded into the hernial sac was somewhat inflamed; it presented spots of vascularity and of ecchymosis, and was agglutinated to another portion of intestine, not, however, so as to offer the slightest obstacle to the continuation of the ordinary functions of the bowel. The wounded part was completely concealed from sight, as was every portion of the ligature, by a copious effusion of lymph. It was a beautiful specimen of the initiatory process of nature to repair injury, and there could have been no doubt that the ligature would ultimately have been passed off through the alimentary canal, if life had not been extinguished from other causes. The brain was examined, but no anticipation of a morbid condition had been previously entertained by any person. Mr. Lawrence, indeed, stated that he wished to see the contents of the cranium only to have an opportunity of contemplating the appearance which

nnealthy brain would present. The actual state of the brain and its mem

branes, when the examination was made, was a subject of surprise to all present. Upon the calvarium being removed, the vessels on the surface of the dura mater seemed numerous and dilated, and the blood flowed in some quantity when it was cut. The arachnoid membrane was remarkably thick and opaque, and gave a dilute milky appearance to the convex surface of the brain. A copious serous infiltration into the pia mater had also taken place; so that when the dura mater was removed, the two hemispheres appeared as if they had been covered with a layer of thick jelly, or (with reference to the colour and consistency) of blanc-mange. Yet during the time that the man was in the Hospital, he exhibited no symptom whatever of confusion of intellect to lead to the suspicion that such preternatural changes existed in his brain. It was mentioned in the dead-house by one of the gentlemen present, who minutely inquired into the history of the patient, that he had had a paralytic attack in the left arm. The right side of the brain was accordingly minutely examined, when upwards of three ounces of a very pellucid fluid were found in the right lateral ventricle. The right corpus striatum had lost its colour; it was light brown, and in a flaccid state, and on continuing the examination, the adjacent structure was found to have experienced a similar change. Mr. Lawrence had no doubt that this alteration was produced by the effect of an effusion of blood into the corpus. The blood was absorbed, and the same result followed as takes place from the same causes in other parts of the body.

Mortification of the Toes from Cold. Richard Wilson, a boy about 16 years of age, was admitted into the Hospital on the 26th ult. on account of mortification of the toes of the right foot, under the care of Mr. Earle. The poor boy appears to be half idiotic; and therefore the account which he gave of the cause of his

complaint could not be relied on, But the persons who brought him to the Hospital stated that he was found in a most distressing condition, and that the disease under which he laboured was produced by continued exposure to the inclemency of the weather. On a close examination of the boy, after he had been placed in bed, there were found black patches over numerous parts of the body, which could not readily be referred to any other cause than great violence. Inquiries were instituted, and there is reason to believe that the marks about the boy were the results of the sort of chastisement which was inflicted upon him in a workhouse, of which it appears he had been an inmate for some time, but from which he had at last made his escape.

One of the toes nearly dropped off on the morning of the 28th ult., and there is some danger of the remaining

ones.

GUY'S HOSPITAL.

Hydriodate of Potass in Scirrhus Uteri.

MR. ASHWELL has tried and is still trying the hydriodate of potass, in the form of suppository in scirrhus uteri, in the obstetrical wards of Guy's Hospital. His formula is composed of 2 or 3 grains of the hydriodate, and 6 of extract of hyosciamus, introduced into the rectum every night. The most decided improvement has been effected in six well marked cases, by this remedy. The general health was of course attended to by mild aperients and tonics. The facts proved by this report are in direct opposition to the experience of Dr. Elliotson, who proclaims to the world that hydriodate of potass may be given in drachm doses, and is merely a diuretic.

(Mr. M. D. Darwin, of Bedford Street, has lately read a paper on the causes of deafness, and on diseases of the ear, at the Medico-Chirurgical Society of the Medical School, at the Westminster Dispensary; in

which he detailed several cases of deafness, caused by an impervious state of the eustachian tube, in which a perfect cure was effected by iodine, given in the form of tincture, according to the formula of Dr. Manson, of Nottingham. The medicine was

given in water, and not as draughts, which accords with the recommendation of M. Lugol, who states the tincture will be decomposed in a short time, if mixed with water. We can bear our testimony in attestation of Mr. D.'s success in treating diseases of the ear, and of his high attainments as a surgeon.)

Rheumatitis.

Richard Daniell, æt. 28, a waiter, admitted under Dr. Cholmeley, Dec. 14, 1831.

Is of a pale complexion, delicate constitution, and of an irritable nervous habit. States that he is married, and has lived regularly, but from his occupation has been much exposed to changes of temperature. His present illness commenced seven days ago, with pains in the knees, hips, and elbows, accompanied by great difficulty of breathing. He was bled and blistered, and had some medicine, which relieved his respiration. He says that he had typhus when nine years old, since which period he has been subject to palpitation of the heart. The right wrist is inflamed and swollen, tongue coated with a yellowish fur, bowels not opened; since yesterday, skin moderately warm; pulse 105, sharp and hard; urine light coloured; has had a slight attack of rheumatism about four years ago.

V.S. ad 3xij. Submur. hyd. gr. iv. Pil. antim. opiat. fort. h. s. Jalap. Ammon, acet. c. vini antim. m. xxx. 4tis horis.

The pain is less this morning, but is increased when the medicine is taken. Tongue moist and nearly clean. No thirst, bowels opened twice, dejections loose, and yellow, and afford relief. The most painful joint is the left wrist, which has become affected since his admission; pains of the other joints much diminished; pulse 105, full, hard, and bounding; urine high-coloured, and turbid; blood drawn yesterday considerably cupped, and buffed. Jalap and magnesia were administered, and the pills continued.

16th.-Much better, slept well, slight dejection. Ordered this morning a dose of house physic; tongue moist and nearly clean; no sickness; pulse 108, rather soft; skin moist, but hot; complains of very little pain in the joints. Pil. ant. opiat. fort. c. cal. gr. ij. omni nocte.—Pergat.

17th. He is much better, the mest painful joints are the fingers and toes; bowels once copiously opened; pulse 108, full; skin rather hot; no thirst; urine high-coloured, and turbid.-Pergat.

18th. Improving; tongue cleaner; little pain in any of the joints; pulse 108, full, and rather incompressible; he felt a slight spasmodic pain in the right hypochondrium this morning, which was relieved by taking warm water; bowels freely opened, and offensive. Pergat-haustus statim sumendus.

19th. Says he is better; bowels regular; urine high-coloured, and turbid; slept pretty well, no perspiration; tongue dry, the centre coated with a yellow fur; pulse 144, sharp. Calomel gr. j, c. Pulv. Doveri gr. iiij. hora somni.-Pergat.

20th. Continues to improve; great pain in the left knee and hands; tongue improved; bowels opened once yesterday; pulse 96; no thirst, appetite much better.-Pergat.

21st. Still considerable pain in the shoulders, arms, and hands; slept well during the night; bowels once opened; pulse 90, full.—Pergat.

22d.-Feels rather better, but suffered more pains in the night in his left hand and wrist; tongue coated, with a yellow fur; troubled during the night with flatulence; pulse 108, sharp. Hirudines parti dolenti, Decoct. Cinchon. c. Iod. Syrup. Aurant. et Tinct. Ejusdem aa; 3js, 4tis horis. -Pergat.

23d.-Improving.-Pergat.

24th.-Better; pulse 90, and soft; bowels opened, not freely; appetite good. To take milk and arrowroot. -Pergat.

25th. Great pain in the right hand and knee, in other respects better; bowels open, dejections unnatural and offensive; tongue nearly clean; pulse 72.-Pergat.

26th.—Troubled with great pains last night in both arms and hands, but is better this morning; tongue as yesterday; pulse 92; bowels not opened; ordered a dose of castor-oil.-Pergat.

27th. Much better, less pains in the arms and wrists; bowels twice opened; slept well; pulse 96, small; tongue clean.-Pergat.

28th.-Better.-Pergat.

Jan. 1st, 1832.-Continues improving; middle diet.—Pergat.

3d.-Sleeps well; bowels opened once; tongue clean; pulse 96, rather sharp.-Pergat.

17th.-Dismissed, perfectly cured.

ST. GEORGE'S HOSPITAL. Iodine in Ovarian Diseases. DR. SEYMOUR is now employing iodine in diseases of the ovaries, with manifest advantage. The diminution of ovarian tumours is most remarkable.

MIDDLESEX HOSPITAL.

Iodine in Cancer of the Face. SEVERAL cases of cancer of the face are being treated with iodine, by Professor Mayo, at the recommendation of M. Magendie, which was given when that distinguished physiologist was on his way to Sunderland. The

Cholera-new Mode of Treatment.

DR. Murray, of Dublin, whose work "On Heat and Humidity" has proved him to be a physician of no ordinary acquirements, has favoured us with a copy of a letter, addressed to Dr. Fergusson, who was lately appointed by the Irish government to investigate the nature of cholera at Sunderland, Newcastle, &c. which contains some curious original views, well worthy of consideration. It will be seen by the date of the letter, that the administration of ammonia by the lungs, and skin, and especially over the spine and epigastrium, is an original proposition. Ammonia has been given by the mouth, since the following letter was written. Dr. Murray has termed it a new and cheap atmospheric blister, in his work already referred to, and which was published in 1829.

[Copy of a letter to Dr. Fergusson.]

Dublin, January 3d, 1832. Sir,-At this moment of dismay, I think it my duty to explain more fully the opinion I have already mentioned to you, that whatever the remote cause of cholera may be, the proximate one seems very similar to those which would arise from the evolution of cyanogen in the solids and fluids of our system.

The cold, black, and clotted blood, the progress of the malady, and the motion of the muscles after death, all appear like the effect of prussic acid, formed and circulated through the

frame. Some latent influence seems to produce derangement in the natural combination of the ultimate elements of our bodies, and to dispose them to combine in new and untoward proportionals, incompatable with the laws of life, or a state of health. As mentioned in my Treatise on Health it seems that the deleterious cause has the power to break up the healthy principles composing our blood and tissues, and to make them join in the altered and disordered atomic proportions constituting the basis of poisonous prussiates.

When therefore some of the proximate principles of our constitution are decomposed, the alternate elements which had formed them may produce new results when acted upon by some occult agency. Thus the carbon and nitrogen may be disposed to combine. in proportions calculated to form prussic acid or its basis; and the oxygen and hydrogen then set free would constitute water, which fluid (as pointed out in my treatise) would account for the blackness of the blood.

I have already mentioned to you, that if nascent prussic acid pervade the human system or cavities of the body during this Asiatic epidemic, an atmosphere of ammonia diffused through the air of the apartment so as to be easily respirable, might be a manageable, economical, and beneficial antidote.

The generation of ammonia in sick rooms would maintain and convey uniform heat to the patient, and being imbibed in hot vapour of water by the skin and lungs, might counteract the further evolution of disordered animal products.

As a mode of prevention, the air of suspected or infected chambers might be deprived of malignant miasmata by a proper impregnation of ammonia.

The mode of procedure detailed in my dissertation, page 272, would convey a continued warm vapour of ammonia and water around the patient