STRANGULATED HERNIA TREATED BY OPIUM. in shortening the duration, or mitigating the severity of hooping cough. 319 persisted for some time, and circumstances permit, great benefit is derivable from change of air. During the earlier period, however, the observance of an uniform and rather warm temperature has the advantage of preventing the supervention of bronchitis, thereby materially lessening the danger of the disease, and also increasing the efficacy of other treatment. CASE OF STRANGULATED FEMORAL HERNIA SUCCESSFULLY TREATED BY OPIUM. The morbid appearances met with on examination of those who have died from this disease, may be supposed to favour the inflammatory doctrine, as in a large proportion of such cases bronchitis has been the cause of death; this, however, only confirms what has been already stated,-viz., that bronchitis frequently supervenes on pertussis. So far as my own experience extends, I would say that more fatal cases have been owing to the accession of cerebral than of pulmonary disease; the preponderance of the one or other appearing to be, in a very great By CHARLES MAYO, Esq., F.R.C.S., Surgeon to the measure ascribable to the progress made in the process County Hospital, Winchester. of teething, during the operation of which à majority of fatal cases has been in consequence of the supervention of head symptoms, even when bronchial inflammation had been previously present. Thus, during one very general epidemic of hooping cough, in the treatNot observing that any other correspondent has ment of which I was extensively engaged, about seven-given you the result of his experience in the treatment teen years ago, the most common fatal termination was either by convulsions or effusion into the cavities, and between the membranes of the brain. From the length to which these remarks have extended, I must now be as brief as possible in regard to treatment. In hooping cough I have never seen any actual benefit result from depletion, except where active inflammation was in existence; on the contrary, positive injury appeared, in several instances, to follow its adoption. This observation applies both to the general and topical abstraction of blood, which seemed not only to exert no influence in diminishing the severity of the paroxysms, or curtailing the duration of the disease, but also to add to the already morbid sensibility of the system. Full emetics, repeatedly given, aided by alkalies, with cochineal, were, in the simple form of the disease, most efficacious; to which may be added, the internal and external employment of sedatives, as the hydrocyanic acid and the tincture of hyoscyamus internally, and friction of the spinal region of the chest, either with the soap liniment with opium, or camphorated oil, either of which I have found more useful than more stimulant embrocations. Of the emetics, ipecacuanha, alone, or in combination with small doses of the sulphate of zinc, has been preferred to antimonials. Where, in addition to the hooping cough, the patients suffered from bronchial irritation, the ipecacuanha wine, or the antimonial wine, was advantageously added to the alkaline mixture with cochineal. From papers which have been recently written on the utility of the carbonate of potass with cochineal, it may not be irrelevant to state, that such combination has been in use for a very long period, I having first met with it in a manuscript of formularies used by my late father, who copied it, when a young man, either in London or Edinburgh, and used it extensively in his practice. When the disease has TO THE EDITOR OF THE PROVINCIAL MEDICAL AND SIR, of strangulated hernia, after the manner recommended by Dr. Butler Lane, in the Provincial Journal of the 21st ult., I beg to send you the following case, which seems to be strongly confirmatory of his views. Mrs. D., aged 67, became subject to femoral hernia on the right side about four years ago, at which time it was strangulated, and after some trouble I succeeded in reducing it by the taxis. Since that time she had worn a truss, and was careful to keep it reduced. The truss had now become broken and nearly useless. After some unusual exertion on the morning of the 24th of April, she felt a large portion of bowel suddenly to protrude, she became sick, took opening pills, and laid up. On the 25th she sent to me; I found the swelling as large as an egg, painful, and tender, from her having used much exertion in endeavouring to reduce it, or push it back, as she said. She was constantly sick. I gave her a cathartic enema, and used the taxis without effect. I then left her six pills with a grain of opium in each, desiring her to take one every hour till I saw her again, beginning at four p.m. At nine o'clock I found that she had taken four of the pills, that the vomiting had ceased after the first, and that she was quite easy; cold cloths were kept applied to the swelling, which remained immovable. As she was so easy, I advised the two remaining pills to be taken at intervals of four hours, another glister to be thrown up in the course of the night, and a cathartic draught to be given at six in the morning. April 26th. I received a message this morning that Mrs. D. was completely relieved, and on my calling about twelve o'clock, I found that the fifth pill was taken at midnight, and the sixth at four in the morning; after this she felt completely relaxed all over, her bowels rumbled about, and the swelling seemed to be enlarged and distended with wind, but soon after on feeling it with her hand, it had become softer, and presently went entirely up under very slight pressure. She took the draught at six, it had operated satisfactorily, and she was delighted to sleep all the day after. I was not less pleased to have the necessity for an Your obedient Servant, Winchester, May 26, 1847. OPIUM IN STRANGULATED HERNIA. [The following case, reported by Dr. Richard Long, of Arthurstown, appears in the Dublin Medical Press for May 12, 1847, and taken in connection with the preceding case, and those reported by Dr. Butler Lane, will probably interest our readers.] On the 11th of January, 1847, I was called to Mrs. P., aged 47, whom I found suffering from intense pain in the lower part of the abdomen; thirst insatiable; incessant vomiting of a brown coffee-coloured fluid; pulse small, 110; extremities cold; countenance anxious and sunken; bowels constipated. This had been her state ever since the evening of the preceding day, now sixteen hours. A pill containing three grains of opium and two grains of calomel was directed to be given every hour, and an enema of strong chicken-broth thrown up every fifteen minutes, in order to support her failing strength. The three pills first given were speedily rejected; the fourth and fifth were retained; a cessation of pain and vomiting followed, and by the time that eight pills were given an urgent desire to evacuate the bowels followed the administration of one of the broth injections, which led to relief and perfect recovery. [Cases of the successful employment of opium and its preparations in the treatment of strangulated hernia, have been reported also by Dr. A. W. Davis, of Presteign, (Provincial Medical and Surgical Journal, Aug. 28, 1841.) Dr. David Bell, of Carlisle, (Monthly Journal of Medical Science, Sept., 1841; Braithwaite's Retrospect, v. 4., p. 149.) Mr. George Cooper, of Greenwich, two cases, (Medical Gazette, Feb. 18, 1842.) Dr. James Ross, (Monthly Journal of Medical Science, Jan., 1843; Braithwaite's Retrospect, vol. 7., p. 239.) Mr. J. M. Walker, of Newcastle-on-Tyne, (Medical Gazette, Jan. 12, 1844.) Mr. J. W. Rowlands, of Ironbridge, (Provincial Medical and Surgical Journal, Feb. 5, 1845.-Ed.] REPORT OF THE DISEASES AND MORTALITY By FRANCIS BUCKELL, Esq., M.R.C.S. On examination I found a firm inelastic tumour, about the size of a large egg, in the right groin, not very painful to the touch; the abdomen was slightly swollen, and very tender. It appears that she has had an inguinal hernia for several years, for which a truss used to be worn, but this for some time past had been TO THE EDITOR OF THE PROVINCIAL MEDICAL AND laid aside. As it was evident the gut was strangulated, I had the woman placed in a warm bath and bled her, and then tried reduction of the protruded bowel by the taxis without effect; a tobacco enema was thrown up, and the taxis again tried ineffectually. As I was now obliged to leave my patient, an anodyne draught was given, a pill containing half a grain of opium, and one grain of calomel ordered every hour, effervescing draughts occasionally, pounded ice to be kept continually on the hernial tumour, and the bath to be again used during the night. I was prevented from again seeing Mrs. P. until noon of the 12th, when I found her situation most alarming. The pulse was at 126, small and hard; countenance still more sunken, and of a leaden hue; vomiting incessant and stercoraceous; abdomen more swollen and tender; hernial tumour unaltered; occasional hiccough. A tobacco enema of full strength was thrown up, and the patient again placed in a warm bath. Whilst she was under the complete influence of the tobacco, every prudent effort at reduction was patiently, but ineffectually tried. The necessity of an operation seemed now inevitable, but the patient or her friends would not hear of it. I therefore, as a dernier resort, determined to try what opium in large doses would do. SIR, SURGICAL JOURNAL. I have forwarded the following tables for insertion in the Journal, as an accompaniment to the meteorological observations recorded at Romsey. With regard to the tables themselves, I would just remark, that thay are not strictly comparable with each other, inasmuch as the Sick Register is drawn from the practices of but two out of five practitioners; whereas the deaths and births apply to the entire district. The proportion of measles is higher than would ordinarily occur in general practice, as about thirty of the patients were inmates of the poor-house. Amongst the deaths is one from hooping cough, whilst this disease is not found in the Sick Register, no cases having happened, either in my own or the parish practice; and I believe but very few in the district. I shall refrain at present from any farther observations on the tables, as it can be only by a lengthened series of such records that striking or important results are to be expected. I am, Sir, Yours respectfully, FRANCIS BUCKELL, M.R.C.S. Romsey, May 15, 1847. The above table is compiled from the Parish Register, and the list of Cases which have occurred in my own practice. FRANCIS BUCKELL, M.R.C.S. This Table and the Table of Births which follows, are taken from the Parish Register. REGISTER OF BIRTHS; SCIRRHOUS TUMOUR OF THE BREAST. REMOVAL OF A SCIRRHOUS TUMOUR OF THE BREAST: INHALATION OF ETHER. By W. M. TROUSDALE, Esq., West Butterwick. Mrs. Barnard, of West Ferry, aged 62, of bilious temperament, mother of two children, first perceived a small tumour on the lower part of the right breast about two years ago. Lately it had increased much in size, and become painful. It presented all the characters of scirrhus, being hard, circumscribed, and moveable. The skin covering its surface was slightly adherent and puckered, but the nipple not retracted, nor the glands in the axilla affected. On May 8th, I operated for its removal, in the presence of Mr. Robert Eminson, of Scotter, and my assistants. The vapour of æther was previously administered from Bell's apparatus. The patient inhaled it seven minutes, when she became perfectly insensible. The excision of the tumour was then effected in about three minutes, by two elliptical incisions, of seven inches in length, including the nipple, and a greater portion of the breast, and two small arteries required to be tied. During the operation the patient talked deliriously, and appeared quite unconscious of what was being done. On her return to consciousness, which took place in ten minutes, she was asked whether she had felt any pain, and replied, "Not the least: I know nothing about it.” Whilst inhaling the æther, her pulse rose from 75 to 110, but soon after subsided to 90. She complained of headache and considerable stiffness of the muscles for a few days, but had no other unfavourable symptoms. Hospital Reports. LIVERPOOL NORTHERN HOSPITAL. A report of the medical cases treated at the Northern Hospital, during the year terminating 31st December, 1846, was lately read to the Liverpool Medical Society, by Dr. Turnbull, one of the physicians to the hospital. The following is an abstract of the paper :~ At present the hospital contains 104 beds, but it can accommodate 180 patients, when the completion of the docks at the north end of the town will render increased accommodation necessary. The institution was originally intended chiefly for the reception of accidents, and acute or urgent medical cases; and though it has, since the new building was opened, assumed more the character of a general hospital, the medical, as well as the surgical cases, are still chiefly of the same severe description. The severity of the cases arises from the hospital being situated near to the most densely populated and unhealthy part of the town, and from being also close to the docks and shipping. From the latter it received many bad cases of scurvy, dysentery, pulmonary consumption, and various organic diseases, which, from their nature, or from not being attended to at sea, are peculiarly severe and fatal. During the year 1846, the number of medical cases admitted was 731; of surgical, 889;-that is, 1620 patients treated in the hospital. To these must be 323 added 94 remaining from the preceding year, and 789 outpatients, (chiefly slight accidents,) making in all 2503. Of the 731 medical cases, there were 59 classed as febrile diseases; 29 of these were cases of intermittent and from the coast of Africa. In this class there was fever in seamen, most of them from the United States, but one fatal case. Of rheumatic affections there were 149 cases, three of which were fatal. Of diseases of the nervous system there were 66 cases, and five of them fatal; three died from apoplexy, one from hemiplegia, and one from intoxication with rùm. Of diseases of the respiratory organs, there were 152 cases, 29 of which proved fatal. Of the latter, 17 were cases of pulmonary consumption. Of diseases of the organs of circulation and of the blood, there were 30 cases, and eight of them proved fatal. There was one death from purpura hæmorrhagica, two from scurvy, and five from disease of the heart. Of diseases of the stomach and intestinal canal, there were 155 cases; and of these, 20 were fatal. There were 105 cases of diarrhoea and dysentery, 16 of which died. Of diseases of the liver, there were 21 cases, two of which were fatal. Of dropsy, there were 33 cases, six of which died. Of diseases of the urinary organs, there were five cases; of uterine diseases, ten; of secondary syphilis and skin diseases, 39; of diseases of the eye, four; and eight cases of other diseases not classified, including one fatal case of inflammation of the air passages from the fumes of nitrous acid. The rate of mortality in 1846 was higher than usual. The total number of cases treated in the hospital, excluding those remaining from the preceding year, and out-patients, was 1620, and the deaths, 135, or one in 12; 731 were medical cases, of which 74 died, or one in 93. From comparing this with a table for the year 1843, I find that the mortality was above the average, 42 deaths having occurred in that year in 507 medical cases, or one in 124. That the mortality should have been higher than usual, does not, however, seem surprising, when we find, from the reports of the Registrar General, that it was much above the average over the whole kingdom, (50,000 in England and Wales above the average in 1846,) chiefly owing to the prevalence of diarrhoea and dysentery. In the Northern Hospital these diseases proved fatal in sixteen cases, thus standing next to pulmonary consumption, which was the cause of death in seventeen. It should, however, be observed, that a higher rate of mortality might at all times be looked for in this hospital than in most others, owing to the ordinary state of health of the population from which it receives many of its inmates, and the severe nature of the cases. The annual mortality of the whole population of Liverpool is about one in 28; so that it would seem that the deaths among the medical cases during their period of sickness in the hospital was three times greater than among the whole population annually. The recent extensive emigration from Ireland, which |