examination can prove, is free from all disease; so that the failing of the circulation so completely may fairly be attributed to the effects of the cannabis. There is one point particularly worthy of note, viz., the length of time that the symptoms came on after the administration of the medicine; and I would ask, had she remained quiet in the recumbent position, would the more violent symptoms have been avoided? Upon all those points which appear of interest, and upon the effects which others have observed to follow the exhibition of the cannabis, I am most anxious to learn their experience; and in order to gain such information, I have been induced to lay thus at length before the readers of the Provincial Journal, the foregoing case and observations; and feeling, moreover, as I do, most strongly, that it is the duty of every man to give to his professional brethren the advantage of his experience, which important object this Journal is so well calculated to carry out. Clifton, February, 1847. CASE OF POPLITEAL ANEURISM TREATED BY COMPRESSION. By ALBERT NAPPER, Esq., Surgeon, Guildford. Mr. Mk, aged 70 years, a healthy looking man, of tall spare frame and temperate habits, consulted me on the 23rd of August, 1846, for a swelling in the left ham. On examination, I discovered a tumour about the size of a hen's egg, soft and yielding in the flexed position of the limb, but tense and elastic when in an extended state, and projecting considerably beyond the level of the flexor tendons. He had first noticed it about six weeks before, when it was the size of a walnut, and it had gradually increased to the present size. The land which he farms is in some parts very steep, and he attributes the injury to the strain on the limbs in climbing the hills. By careful examination, a distinct pulsation can be felt in the tumour, which becomes flaccid on compressing the femoral artery. No bellows. murmur can be detected, and the pulsation in the lower part of the femoral artery is very weak. 25th. Applied a moderately thick piece of sole leather, previously softened in hot water, over the popliteal space, extending about six inches above and below the joint, and four inches wide, and a similar piece on each side, so as to envelope the limb, with the exception of a narrow space on the upper surface, over which a bandage, sufficiently tight to obtain an exact mould of the inclosed parts. Is not to be confined, but directed to abstain from much exercise. 27th. Removed the leathers, which were well adapted to the joint; but as that covering the tumour did not appear to possess sufficient resistance, it was lined with several layers of lint, steeped in a mixture of white of egg and flour, and over that a thin piece of leather, softened in hot water, and again adjusted as before. 30th. Removed the splints; the lower one is now firm and resisting as a board, and has a complete mould of the tumour. 6th. Finding no alteration, I determined on trying the effect of direct pressure on the tumour; I therefore placed upon the swelling several layers of lint, steeped in white of egg and flour, to the thickness of half an inch or more, and again applied the splints firmly. Up to this time he has continued to ride on horseback, but is now to be confined to the house. 8th. Tightened the bandage without removing the splints. 12th. Finding, on removal of the splints, that the compress had only had the effect of flattening the tumour, in which the pulsation is still to be felt, I determined on applying a more effectual compress. I therefore placed the half of a wine cork, split longitudinally, just above the depression in the splint, corresponding with the tumour, and covered it with lint steeped as before, in white of egg and flour, so as to obtain a direct pressure on the artery, immediately above the sack. The splints were then adjusted as before, but with the addition of three or four broad tapes with buckles, firmly stitched to the lower splint to prevent any displacement, and which I afterwards found to be much more effectual than the bandago alone. Assuming that, from the pressure already applied for the space of seventeen days, during which time the patient had not been restricted from exercise of the limb, the collateral circulation was somewhat established, I applied the splints by means of the tape straps, sufficiently tight to nearly or quite obstruct the circulation through the sac, but before leaving my patient, who resides at some distance from me, I gave instructions to his wife as to the management, in the case of the limb assuming a state of venous turgescence. He is now directed to keep the recumbent posture. 15th. Appears to be doing well. His wife informed me that within an hour after I left him on the 12th, the leg became exceedingly turgid and of a deep purple hue, accompanied with numbness and loss of temperature, but through her judicious treatment, this was subdued by slightly loosening the lower strap, and applying friction with warm fomentations. From this time no alteration was made except an occasional tightening of the straps, until Oct. 3rd. Removed the splints; tumour much diminished and flaccid, but no pulsation to be detected; a small vessel is felt pulsating over its surface. The ends of the cork, from being left too sharp, have produced slight excoriations of the skin. This was rectified, and the compress adjusted as before. 11th. Removed the splints; tumour much diminished; compress re-applied as before. 15th. The cork compress was now replaced with one made of tow wrapped in lint; the tumour scarcely to be felt. 18th. Continues to improve; he now walks out every day. Nov. 27th. The leather splints producing but little inconvenience, have been worn to the present time, though I believe for the last month they have been quite unnecessary. They are now removed, and a simple Sept. 1st. The splints were again removed, and the bandage applied. The artery can be felt as a hard tumour found in much the same state. cord in the recent situation of the tumour, and the small vessel above alluded to, pulsating immediately | vomiting and occasional hiccough; no pain or tenderover it. January 22nd, 1847. On visiting Mr. M to day, I found him as well as before the occurrence of the aneurism. A distinct pulsation can be felt in the anterior and posterior tibial arteries. ness of the abdomen; countenance depressed; pulse not much accelerated, and of good strength; urine rather diminished in quantity, but not considerably so; tongue moist; thirst. A large quantity of warm water with some turpentine was thrown into the colon with the long tube; it immediately returned without any fæcal matter, but occasioned an escape of flatus, which afforded some relief. Afterwards five grains of calomel were given, and repeated in three hours; this allayed the vomiting for a time, but did not produce any evacu ation. He says that several years previous he was affected in a similar way, and that the constipation continued for five or six days, the greater part of which time he was obliged to lie on his back in consequence of an injury. A dose of castor oil and turpentine was given, but immediately rejected by the stomach. He continued to get worse; the vomiting and hiccough were incessant. Expressing a desire to be placed on the night-chair, his wish was acceded to, but nothing was passed. The difficulty experienced in all the cases hitherto reported, of keeping the compress on the femoral artery, and the pain produced by its pressure on the saphenus and branches of the crural nerves, induced me to try the above method of compressing the artery on the popliteal space; but had I felt disposed to treat my patient by means of any of the ingenious contrivances invented for the purpose, I should probably have failed, owing to the distance (seven miles,) at which he resides from me. The complete success of the above simple method of treatment I trust will be a sufficient apology for my offering it to the notice of the profession, and though it may not be applicable in every case, I believe in the majority of cases seen in an early stage it will | be found successful. I think an improvement might be made by removing a portion of the splint, corresponding with the seat of pressure, just large enough to admit the pad of a tourniquet, by which means any amount of pressure might be applied without a possi-injection returning there was a pretty free discharge of bility of the least displacement of the compress, and with a little contrivance, aneurisms in other situations might be similarly treated. It is worthy of remark, that during the whole course of treatment the patient suffered no pain, though I now believe the pressure was kept up considerably longer than was necessary. He also during the whole time walked every morning into an adjoining room, and back in the evening, and was allowed to vary his position in bed as he felt disposed. Guildford, January 27, 1847. On the morning of the 10th the long tube was again used, it passed up freely, and a very large injection of warm water and turpentine was given. On the dark-coloured fluid fæces. The vomiting and hiccough continued, but were temporarily relieved by æther and opium, and the bowels acted pretty freely several times. He became gradually worse, and died on Monday, 12th. For the last two days it was requisite to draw off his urine, which was abundantly secretedThe vomiting, hiccough, and tympanitis, continued to the last, but without pain or tenderness of the abdomen. Autopsy. Intestines generally distended; no traces of peritonitis. On pushing the small bowels on one side, a tumour about the size of a duck's egg was observed lying on the pelvis, and connected with the great omentum, which it dragged down, and formed a CASE OF SUPPLEMENTARY SPLEEN, CAUS- band of cord which passed in front of the large bowel ING DEATH FROM THE PATIENT BEING PLACED IN THE SUPINE POSITION, IN CONSEQUENCE OF A FRACTURED THIGH. By W. H. BAINBRIGGE, Esq., F.R.C.S., Surgeon to the Northern Hospital, Liverpool. at the commencement of the rectum, pressing it against the posterior part of the brim of the pelvis. When on his back the tumour would necessarily fall into the cavity of the pelvis, and cause the cord of the omentum above described to exert so much pressure on the bowel as to impede its functions. On further examination the tumour was found to be a supplementary spleen, enclosed between the layers of the omentum, and receiving for its supply one of the divisions of the splenic artery, which in fact divided into two branches, one to each spleen. May 5th, 1845, James Hughes, aged 53, a groom, of temperate habits, was admitted into the Northern Hospital under my care. While exercising a horse, a short time before his admission, the animal reared, and fell npon him; he was immediately brought to the hospital, and found to have a simple fracture of the left thigh, which was put up in the usual way with the The above case is chiefly interesting in a physiolong splint. He went on very well for two or three logical point of view. Pathologically regarded, (beyond days, when he complained much of pain in the back, the circumstance of death being caused by the pressure which was relieved by placing a pillow under it. In of the contracted portion of the great omentum,) it the evening he complained of swelling of the abdomen, possesses no feature of practical interest, as there were which was tympanitic, but free from pain. The bowels no means of ascertaining that this pressure was caused had not been opened since the accident. A turpentine by the position of the patient, and that of the suppleinjection, a dose of castor oil, and turpentine mentary spleen. It is, however, interesting, as being fomentations to the abdomen were prescribed. The one fact more added to the list of anomalous cases of enema returned without bringing away any faecal the kind on record. Singularly enough accidental matter, but there was a free discharge of flatus. change of posture on the part of the patient would Next day, May 8th, the tympanitis continued; he had have removed the mechanical obstruction, and saved life, as it seems to have done in the previous attack of constipation. The existence of accessory spleens is a well-known physiological fact; their occurrence, however, is very rare; their varieties are numerous, and they are usually found in the lower extremity of the organ, not far from the fissure either in the gastrosplenic ligament, or, as was the case in the present instance, in the great omentum. Their form is commonly round. That found in this case was in shape precisely like that of the spleen itself, and that it was identical in structure will appear from the following statement, for which I am indebted to Dr. Inman, who was so kind as to examine it microscopically for me:"The spleen you exhibited last night possesses conclusive proofs of identity in the peculiar disposition of the arteries and veins in its tissue, in its well-marked fibrous and trabecular character, and the remains of the Malpighian corpuscles, in the existence of a few distinct granules with the remains of others, and in the complete absence of anything like a microscopic cell-structure." size of the brain-box, which indicates that the brain was altogether of rather smaller size than is usual. "J. G. CROSSE. "Norwich, February 1, 1847." DISSECTION. Right Ear.-The meatus externus is full of cerumen of a dark-brown colour. The membrana tympani is of a dull white, and somewhat thicker than natural. The epithelium covering its external surface is denser than usual, and its internal mucous layer thick and soft. The middle proper membrane is also hypertrophied. The cavities of the tympanum and the mastoid cells are completely filled with a secretion of a leaden white colour; it is thick, and in some parts rather viscid. Upon microscopic examination it was observed to consist principally of pus-globules pervaded with granules, characteristic of scrofa fulous matter. The mucous membrane of the tympanic cavity is much thicker than natural, it is very soft and contains large tortuous vessels full of dark coloured-blood. The ossicles are quite enveloped, and in a great measure DISSECTION OF THE EARS OF A DEAF AND concealed from view, by this thick membrane. The only NOTES OF THE CASE BY MR. CROSSE. "The patient was 47 years old, or thereabouts, when he died; he was deaf and therefore dumb from birth; his intellect was good enough for him to support himself for many years as a weaver, but about fifteen years since he was so reduced as to enter a Union House, and after being there five years showed such a degree of mental derangement that he was placed in a pauper-lunatic asylum, where he remained until he died. He was for a time very maniacal, but subsequently became quiet, and was subject only to occa. sional attacks, making himself very useful in the asylum in the intervals. I found the cerebrum very vascular on post-mortem inspection; an unusual number of vessels, situated chiefly in the medullary substance, discharging their blood on a section being made. The cerebellum was not more vascular than is healthy. I observed no other anormal state of the auditory apparatus. The calvarium I still retain, but shall be glad to send it up, if required, that it may be joined to the rest of the bones of the head, to show the actual part of the stapes discernible, is the point where it joins with the incus. The Eustachian tube is healthy. The auditory nerve and cochlea appear quite healthy; the fluid in the vestibule and semicircular canals is quite transparent, but the membranous labyrynth is rather thicker than natural, and under the microscope it is seen to contain numerous blood-vessels; the superior semicircular canal is incomplete at its posterior half, and the posterior canal is almost wholly absent. The left ear is in a similar state to the right, excepting that the external meatus is slightly contracted, and the layer of bone separating it from the cavity of the mastoid cells is partially absorbed at the posterior surface of its internal extremity for a space of five or six lines in circumference. The membrane covering this portion of bone, which from its two-fold functions may be called the cutaneo-periosteal membrane, is thick and vascular, and its blood-vessels directly communicate with those of the mucous membrane of the mastoid cells. I have observed an absorption of the layer of bone between the external meatus and mastoid cells in other instances, and in one dissection the cerumen was found projecting from the cavity of the meatus into the mastoid cells. It is not improbable that the absorption of the bone is caused by the constant pressure of hardened cerumen. The superior semicircular canal was almost wholly wanting. As some dissections of the car of deaf and dumb patients have been recorded in the Medico-Chirurgical Transactions, I have thought it best to lay before the Medico-Chirurgical Society a more detailed account of the condition of the semicircular canals, accompanied by drawings. Observations. There can be no doubt that the cause of deafness in the patient from whom the ears were taken was the deficiency of the semicircular canals, but it is interesting to notice the thickened condition of the mucous membrane of the tympanic cavity, and the QUEEN'S HOSPITAL, BIRMINGHAM. 127 R. Infusi Cascarilla, oz. iss., ter die. To have the Uug. Zinci on lint applied to the wounds, and a poultice applied to the abscess. 30th. Rather better; the parts do not feel so hot; in no pain. To have the abscess strapped with iodide of lead plaster. presence of the purulent matter. From the dissections | left side; bowels open; appetite good; tongue clean; I have made during the last seven or eight years, complains of slight cough; the ulcerations in the face which amount at the present time to nine hundred and feel hot; has sometimes a little pain in them, but is eleven, it is quite apparent that the most frequent cause generally free from it. of deafness is a morbid condition of the tympanic mucous membrane. In some instances there are bands, connecting various parts of the tympanic cavity together, and preventing the natural motions of the ossicula and membrana tympani; in others the cavity is nearly filled by the thickened membrane, and very often there are large quantities of thick viscid matter, which I have every reason to believe may remain for many years if not affected by medicinal agents. A great number of cases of this kind originate in scrofulous inflammation. It is also interesting to remark how rarely the Eustachian tube is affected. I hope ere long to lay before the medical profession the results of some of my later investigations into the nature and treatment of diseases of the ear. Hospital Reports. QUEEN'S HOSPITAL, BIRMINGHAM. CLINICAL REPORTS OF SURGICAL CASES By PETER HINCKES BIRD, one of the Resident (Continued from page 100.) CASE XXIII. LUPUS OF THE FACE. Thomas Moss, aged 18, tinman, of strumous diathesis, admitted as out-patient at the Queen's Hospital, April 24, 1846, under the care of Mr. William Sands Cox. He states that about three years ago he first observed two or three small pimples on the nostril of the left side of the nose, and one also appeared about the same time on the right side; they burst and formed scabs, and ever since the disease has gradually increased and involved the other parts; has had swelling of the submaxillary and cervical glands for some time; has always enjoyed good health; his parents are both alive and in good health, as are also his brothers and sisters; is rather subject to cough; has spit blood. Present state. There is a large patch of ulceration involving both alæ of the nose and septum, which are more or less eaten away, on the left side to a greater extent than on the right; the upper lip is much thickened, and is attacked with this ulceration; he has also a large patch on the left cheek, larger in extent than the bottom of a wine-glass, and also one under the chin, which is partly covered by desquamations of the cuticle. The ulceration is superficial and of a dusky red colour, and secretes a thin pus which dries in some places and forms scabs; the edges of the ulceration are tuberculated and the interior presents several small depressions filled with matter. He has also an abscess of a strumous nature on the back of the hand which has been three years in coming; it discharges a thin flaky pus; he has three glandular swellings of large size situated under the ramus of the jaw on the May 5th. The ulceration is not spreading but is rather smaller; there is a slight discharge from some parts of the surface. 16th. Better in all respects; ulceration healing and is certainly less; abscess of the hand smaller; health improved. 22nd. The ulceration is healing and getting into a much smaller compass; it has not broken out in any fresh place; abscess of hand decreasing in size; health good. 27th. Doing well; the ulcerations are getting smaller leaving behind them a livid red cicatrix; the patch on the upper lip is quite healed over. July 8th. Much the same; the large patch on the cheek is healing rapidly; he had a few days ago a violent attack of hemoptysis accompanied with much cough; bas got thinner lately; sweats much in the morning; flushes at times; pulse 90. R. Syr. Papav. Alb., Oxym. Scillæ, utrq. oz. ss.; Inf. Rose. Co., ad oz. vj. M. Sumat oz. j. ter die. July 20th. Rather better; cough easier; expectorates a good deal of greenish sputa; had a slight return of the spitting of blood this morning. 30th. Better; cough easier; the patch on the cheek is nearly healed over; that on the nose is quite so; his face is much disfigured by the livid-red cicatrices left behind. Aug. 27th. He has not made his appearance at the hospital lately, so that we may infer that he is satisfied with his present state. Lupus belongs to the order tubercula. Rayer describes two varieties of this disease, namely, lupas exedens, and lupus non-exedens, to which M. Biett adds a third,-lupus with hypertrophy. The first of these ulcerates from the surface inwards and leaves deep excavations; the second spreads and ulcerates horizontally; the third rarely ulcerates at all. The two latter are tubercular diseases, and are comparatively rare in this country. The lupus exedens is a frightful disease, difficult of cure, and when cured leaving behind it more or less deformity. Mr. Plumbe* doubts whether this form is strictly of tubercular origin. It is in fact a chronic cutaneous inflammation of a peculiar character, at once indolent and irritable, but often for a time devoid of pain, of a livid colour, commencing generally in a small portion of the ale of the nose, or the circumference of the nostril, and speedily tending to phagedenic ulceration; it commonly extends to the • On Diseases of the Skin, Ed. 3rd. upper lip, and in this case the ruthless invader had attacked the chin and cheeks. Of the causes of this disease little is known. Young persons of a scrofulous habit appear more subject to this frightful disease than others. It has, however, been seen to attack persons apparently of the soundest constitution; in this case the patient was without doubt afflicted with tubercular phthisis. It is common in young and previously healthy women from the age of 16 to 30. It is not contagious. This disease is often treated with escharotic applications, such as the chloride of zinc, arsenious acid, &c. &c.; but this case got well under the simple application of the ointment of the oxide of zinc, with a tonic medicine. This disease has often been most inexcusably confounded with syphilis, and has been aggravated by mercurial salivation. In syphilis there can always be traced, at least a concatenation of secondary symptoms previously developed, and this disease usually commencing from within, the cartilages suffering first; and the ulceration has a specific character. In lupus, on the contrary, the disease appears in persons who have generally enjoyed good health, and in whom neither primary nor secondary symptoms have made their appearance; and it appears as a livid red, not a copper-coloured eruption. CASE XXIV. PARTIAL LUXATION OF THE ANKLE-JOINT. Thomas Porton, aged 23, carman, admitted on the evening of August 3rd, 1846. He states that about half an hour previously he slipped off the foot-path into the gutter; he fell with his left foot bent under him; he heard something snap; it caused him great pain, so that he could not walk; he was brought to the Hospital in a car. On admittance, it was found on examination, that the patient had a partial dislocation of the ankle inwards, the lower head of the tibia being thrown inwards, the internal malleolus forming a more considerable prominence than natural; no fracture of the fibula was discovered; there was considerable swelling in the neighbourhood of the ankle; the outer edge of the foot was slightly everted. The dislocation was easily reduced; after the reduction the pain was lessened; he states that his bowels are rather confined. Appl. Hirud. viij. partis affecte. To be followed by a poultice and warm fomentations. Dislocations of the ankle are generally attended with fracture of the fibula in its lower third; but in this case no fracture was present, he rapidly got well, and was able to walk in less than a fortnight. WEST NORFOLK AND LYNN HOSPITAL. COMPLICATED SURGICAL CASES UNDER COMPOUND COMMINUTED FRACTURE OF THE HUMERUS Robert Gant, railway labourer, aged 20 years, admitted May 9th, 1846, under the care of Mr. Cotton. Had fallen across the tram-road of a neighbouring railway in the course of construction, and received considerable injury from a loaded truck having passed over his right arm. The accident happened two hours before. On examination the arm was found much contused and swollen, just above its centre, and ficrid blood oozed freely from an irregularly lacerated wound on the outer side, extending to the bone, which was comminuted and fissured. No pulsation below the seat of injury. Relying upon the age and the robust and healthy appearance of the man, it was determined in consultation to attempt the saving of the limb. The arm was therefore placed by the side upon a soft pillow, guarded with oil-silk. The fragments of bone, (in all five,) constituting about three inches of the shaft, were removed through the wound, one portion requiring to be freed from its muscular attachments by the scalpel. A long projecting point from the upper fractured end of the humerus, reaching to the lower, and overlapping it, was allowed to remain. A dossil of lint was applied to the wound, the injured parts ordered to be exposed, to check the oozing of blood, and a moderate warmth to be kept up about the hand and forearm. Low diet. 10th. Temperature of the arm natural, 11th, Bowels have not acted; is feverish, and fearful lest he should lose his arm. Ordered a saline aperient. 12th. Bowels moved twice; irritative fever very high; several vesicles filled with serum around the seat of injury; the hand is comfortably warm, although sensation is imperfect. Liq. Ammon. Acet., dr. ij.; Habt. Mist. Purgant. Pil. cum Calomel., ij. hora Spir. Æth. Nitr., m. xx.; Vini Antim. Tart., dr. ss. ; somni sumend. Aug. 4th. Slept indifferently last night on account of the pain; not so much swelling; less pain; tongue coated; pulse 86, strong; bowels open. Continue fomentations. 5th. Slept better last night; appetite indifferent; tongue coated. 6th. Did not sleep so well last night; complains of constant pain from the ankle to the knee. 7th. Feels better in every respect; can move the ankle freely. To have a splint applied, the part to be kept damp by cold lotions. 9th. Better; can walk pretty well. 13th. Discharged cured. Tinct. Hyosc., m. x.; ex Aqua, quartis horis. 15th. Considerable phlegmonoid inflammation and swelling of the arm and elbow. A quantity of pus was set at liberty by enlarging the original wound, and making a depending outlet below the elbow. Pergat. 17th. Arm looking better; angry appearance subsiding; discharging freely. Middle diet and porter. From this time to August 14th the case went on well, requiring but little interference; the wound at the elbow had healed, leaving the joint cædematous and swollen; a sero-purulent discharge continued from the upper wound, which remained open, filled with gelatinous-like granulations, and the skin around red. There is an abundant deposition of bony callus around the |