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after which the discharge is profuse, with unusual dis- instances, and the chance of it may be sufficient to turbance of the general system, The great sympathy warrant you in recommending the patient to submit between the uterus and the mammu is very remarkable; to the operation. I have the satisfaction of knowing, and upon this sympathy the affection of the mamma that several persons on whom I have operated under does, in a great measure, depend. Mr. Carmichael | these circumstances, are now alive and well, but who has, however, seen scirrhus of both mammæ in a child, would certainly have been dead long since, had I not aged 12; and Sir Everard Home relates a case in had recourse to it.” which it occurred at the age of 15. On the other I may here remark, that the treatment this patient hand, persons of the most advanced age are not exempt received three months previous to her admission into the from the chance of its development. Dr. Walshe hospital was unwarrantable in the extreme; no man, relates the case of a female under his care who was who understands his profession, would ever think of nearly 70; Sir Astley Cooper has seen the disease in thrusting his lancet into a scirrhous breast; for this a female, aged 86; and Cruveilhier maintains that imprudent act caused in this case, by the irritation it such facts are of almost too frequent occurrence to be produced, the rapid increase in the tumour, and the looked on as esceptional.

throwing out of an extensive fungus, which, by reAccording to the opinion of Sir Astley Cooper, peated bleedings, was enfeebling the patient. scirrhus of the breast occupies from two to three

CASE XXI. years in growing, and from six months to two years

COMPOUND FRACTURE OF BOTH THIGHS AND LEGS. in destroying life; but in this case, the patient only

Samuel Hare, aged 40, labourer on the Gloucester perceived it seven months previous to its extirpation. This case is also remarkable for the absence of pain,

railway, admitted into the Queen's Hospital, on which was never much complained of, and was seldom

| July 29th, 1846, at half-past five o'clock, p.m. It attended with exacerbations; the case is also peculiar on.

is stated that about an hour previously, a loaded account of the number of cysts which occupied the

luggage train passed over the lower part of his body; substance of the breast.

he did not lose much blood at the time. The results of the operation for the extirpation of

When admitted he was in a complete state of progcancer are very unfavourable. Mr. Mayo's experience*

tration, with cold skin, weak slow pulse. On examinabas led him to the conclusion that, “ after amputation

tion, there was found compound fractures of both legs of a scirrhous breast, under the most favourable circum- and thighs, with a large lacerated wound on the right stances, that is to say, when the operation is performed

thigh; very slight oozing of blood from the wound. at the earliest period at which the structural character

Stimulants were administered, but he gradually sank, of the disease has declared itself in the gland, no other

and expired at twenty minutes past six o'clock, p.m. part being yet invaded by it, and the diseased structure

On post-mortem examination the next morning, the being entirely removed, I believe that in ninety-nine following extensive injury was discovered ;--A comcases out of a hundred the disease returns either in the

pound comminuted fracture of the right femur, about cicatrix, or in the axillary or subclavian glands. The

its middle third, with a large lacerated wound, extendoperation, therefore, cannot be performed with any | ing more than six inches from above downwards, and reasonable prospect of saving the patient eventually

four inches across, the muscles beneath on the inner from the disease.” Dr. Macfarlane states that he has

side of the thigh being extensively lacerated and torn; "never seen a case, even of the most favourable descrip

commiputed compound fracture of the right tibia and tion, in which the disease did not return, although every

fibula, the former bone being much shattered at the precaution was adopted to render the operation suc. junction of its middle, with its upper third; a lacerated cessful." Dr. Macfarlane refers to 118 cases, and wound on the outer side of the right ankle, and one although in the majority the parts were freely and also on the sole of the foot; a compound comminated extensively removed, at an early period, and under the

fracture of the left femur, with a lacerated wound of most favourable circumstances, in many instances no

about half the size of that on the right; a very ex. distinct indication of constitutional deterioration being tensive compound commiputed fracture of both the present, yet in all the disease returned both externally

bones of the left leg. and internally, and prored fatal.

No wounds or fracture of any other part of the What then, are the cases in which amputation of body was discovered; the marks made by the carriage & scirrhous mamma may be deemed proper? Sir wheels are very evident on the right thigh. Benjamin Brodie gires the following reply :-“When

The severe nature of the accident caused in this the skin is perfectly sound—when the nipple is not retracted—when there is no diseased gland in the

patient such a prostration of the system, that re-action axilla—when there is no sign of internal mischief

did not ensne; had he revived amputation of both when there is no adhesion of the breast to the parts

thighs above the aeat of injury, would have been the

only chance left for recovery. below-and when the patient is not very much ad. vanced in life, I should say, that there is a reasonable

(To be continued.) cbance of an operation effecting a cure. I do not intend to say that in all expected cases there will be a permanent cure, far from it; but there will be in some

• Outlines of Pathology, p. 573,

NORTH STAFFORDSHIRE INFIRMARY.

than was anticipated. The tumour was as large as a

middle-sized potato, had a nodulated appearance, and CASE OF EXOSTOSIS OF THE TIBIA, AND

a flesh colour, having somewhat the resemblance of OPERATION.

large granulations; but this appearance was only

superficial; internally it had a cancellated bony strucBy J. SEDDOM, M.D., F.R.C.S., &c., lately one of ture. The diameter of its base was nearly three inches.

the Surgeons to the North Staffordshire Infimary. 1 May 3rd. The limb somewhat swelled ; the bandage

Joseph Hubball, agricultural labourer, aged 21, and outer dressings were removed, and lint soaked in married, of florid complexion and healthy appearance, warm water applied. was admitted into the North Staffordshire Infirmary, 4th. Going on favourably; some fever; bowels have January 5th, 1846. About two years and a half ago,

| not been moved. Med. Efferv. 01. Ricini, oz. ss. Appl. bis attention was first called to a "lum" in the upper | Catapl. Lini vulneri. and back part of the right leg, by uneasiness in the 6th. Some erythema about the ankle. Appl. Catapl. part, which was attended with occasional numbness in Lini parti affectæ. the ankle; there is no very marked swelling of the

12th. Going on well; the muscle bulges from the part, bnt the muscles of the calf, on examination, seem wound, but has a healthy granulating appearance ; to be stretched, and a hard tumour can be felt firmly general health good. Middle diet. White lead cerato attached to the upper and posterior part of the tibia. spread on lint applied to the wound, and support giren A pulsating blood.vsssel can be traced on the outer by a bandage. edge of the tumour. The patient thinks the swelling 17th. Improving. Lint wet in sulphate of zinc lotion may have been caused by leaping. Leeches, blisters, applied to the wound, and support given with adhesive and other measures bad been resorted to before bis straps and bandage. admission. He was directed to take Potassii Iodidi, From this time the patient continued to improve. gr. iv., twice a day, and he had a strong compound iodine He was discbarged cured, June 30th. Soon after his solution to apply to the tumour.

discharge he resumed his employment as a farmer's This plan was unremittingly pursued till the middle servant. I have lately heard of him, and learn that of April, but the tumour had become decidedly larger, he is perfectly well, and follows his employment and the patient was now suffering considerable pain. without inconvenience. A consultation of my colleagues was therefore called, The difficulties of the operation which presented when I submitted for their consideration a proposal themselves to myself and colleagues before it was to remove the tumour by excision; this was decided undertaken were:- First, the danger of wounding the apon, and the operation undertaken, May 2nd. vessels and nerve, passing from the poplitieal space;

A free incision, commencing at the lower part of the secondly, it was thought possible that the tumour poplitieal space, and within the inner hamstring, was might extend so far upwards as to endanger the openextended about four inches downwards, on the inner ing of the capsule of the joint; and lastly, if the edge of the gastrocnemius, and parellel with it. This excrescence were of a ftrm texture there might be was continued across the muscle, and carried a little considerable difficulty in detaching it from the bone. upwards, so that the cut had somewhat of a hooked However, as it was considered that amputation of the appearance. By this means, a flap was formed of the linb would soon be required if the tumour continued muscles of the calf, which was turned upwards; two to increase, it was decided to undertake its removal, bleeding vessels were tied at this stage of the operation. having first apprized the patient of the dfficulties and The tumour now became apparent, covered only by an danger of the case. I had no apprehension that the expansion of muscular fibres. The house-surgeon, disease was of a malignant character, as the patient Mr. S. Alford, having drawn aside the vessels and had a healthy aspect, and his general health bad Derve, by means of a booked copper spatula, the always been good. mascular fibres were divided so as to expose the tumour clearly ; it bad an extensive attachment to the tibia, and overhung its inner edge, so as to fill up the

PROVINCIAL ipterosseal space at this part. By means of a chisel Medical & surgical Journal. and mallet applied to its inper edge, it was partially divided; the chisel was then worked into the internal WEDNESDAY, FEBRUARY 10, 1847. structure of the tumour, with the hand alone, and by raising the handle of the instrument, the bony mass

We have lately had our attention drawn to an was forced from its attachment; a few projecting points of bone were remored by the bone-nipper. Some lint

important document from Mr. Chadwick, which, having been applied to the bottom of the wound, the

although addressed to a local authority, the muscular flap was laid down, and a piece of lint placed

Town Clerk of Liverpool, and for a special over it, and this being retained by a bandage loosely purpose, yet contains the enunciation of sound applied, the patient was carried to his bed. Samat principles, of general application in reference Tinct. Opii, min. xxv, e Mist. Camph., oz. j. statim. to the subject of which it treats. Hydrarg. Chlor., gr. iv., hora somni.

This document is in the form of a lettera The operation was effected with much less difficulty I well-merited testimonial to the unwearied zeal,

HEALTH OF TOWNS: MEDICAL INSPECTORS.

research, and talent evinced by Dr. W. H. was, on the average, twenty-one years:-the Duncan, of Liverpool, in his labours for the loss of life of the adults who died in Liverpool, sanatory improvement of that emporium of our as compared with Ulverstone, was on the average, commerce. The members of the Association | twelve years and six months to each individual. will rell remember the series of admirable Supposing the lost labour of these adults to be papers on the epidemic fever of Liverpool, by worth only ten shillings per week, the lost proDr. Watson, published in the Journal of last ductive labour of that year was, demonstrably, year, and it is unnecessary to recal the details a loss of nine hundred thousand pounds. The connected with the sanatory condition of the loss from the excess of sickness which accomtown therein recorded. It will be sufficient for our panies the excessive mortality,--supposing present purpose to state, that among the evidence twenty cases of sickness to one death, and the given before the Health of Towns' Committee, expense of cure or alleviation only one pound to which, and to the reports made to the Commis. per case, must have been one hundred thousand sion of Inquiry, it is mainly owing that the ponnds :--the loss of expense from the excess of attention of the Government and the Legislature funerals alone, at only five pounds per funeral, has been drawn to the subject, the information must have been eighteen thousand pounds during afforded by Dr. Duncan on the sanatory condi- that one year. tion of Liverpool stands prominent. As Mr. “Now, there were at the time of the census Chadwick, in the letter to which we are refer- 165,094 adults in Liverpool. The impending ring, justly states, Dr. Duncan's report on the loss of life to each of these adults is twelve means of improving the health of the population years and a half—that is to say, of death twelve of Liverpool is “one of the most valuable years and a half-before others whose sanatory pieces of service that have in their own time condition is better, will have to submit to the been rendered to that population.” This he general doom. Taking this premature loss of subsequently characterises, in conjunction with life in the pecuniary view merely,-reckoning other similar reports by Dr. Arnott, Dr. Kay, the value of each adult's productive labour and Dr. Southwood Smith, Dr. Laycock, Mr. at no more than ten shillings a week,-the Roberton, and Mr. P. Holland, Dr. Lyon impending loss is at least £325 per adult Playfair, Mr. Clay, Dr. Shapter, and Mr. Baker, individual." on the sanatory condition of the metropolis, of Such is the loss experienced by the population York, Manchester, Lancaster, Preston, Exeter, 1 of Liverpool in life, health, and productiveness. and Leeds, as “reports which advance the new Let us now see what are the arrangements and most important science of prevention, and which are to be made to meet it. Among the indicate the principles of a course of measures, foremost of these is the establishment of an which, if they be completely carried out under efficient system of inspection and the appointscientific direction, it may be confidently ex- ment of a qualified inspector. The actual pected will do more for the improvement of the extent and nature of the evil must be detected moral as well as physical condition of the popni. and laid bare before the proper remedies can be lation than any set of measures that have applied; and these again require to be indicated, hitherto been presented for the public attention.” the best mode of their application to be pointed

The Corporation of Liverpool, roused at out, so as to accomplish the end proposed, and length to the importance of attention to sanatory their working, also, to be superintended by commeasures, are making the necessary arrange- petent persons. ments for carryinginto effect those improvements « The subject matters of the attention of the in drainage, ventilation, &c., which have so long officer of health,” we again quote from Mr. and so loudly been called for. Some details as Chadwick,“ are those causes which affect the to the pressing necessity for this are afforded by condition of the population in the wholesale, Mr. Chadwick in his letter:

causes which frequently cannot be met by “It appears,” says Mr. Chadwick, “that separate and isolated arrangements in single during one year the excess in number of deaths cases. For individual cases, alleviation only is in Liverpool was no less than 10,000 above the in general available; and the business of allegeneral average mortality of the country. In viation or cure, now engages the chief, if not the year when Dr. Playfair examined Liverpool, the sole, occupation in the borough of Liverpool with other towns in Lancashire, the excess in of twenty-seven physicians, 325 surgeons and the number of deaths in Liverpool above the apothecaries, and 365 chemists and druggists.” rate of mortality in Ulverstone, in the same To meet this requirement the wealthy Corpocounty, was 3611. The loss of life by all who ration of Liverpool proposes the appointment died that year, as compared with Ulverstone, of a medical inspector, with a salary of £300 per annum! with liberty to engage in private duties performed throughout the country for a practice !! In reference to the labours of Dr. very inadequate amount of remuneration, for Duncan, Mr. Chadwick observes:

the smallness of which the opportunities afforded “At the very outset, I would say that a pen- for private practice have been held out as an sion of £300 per annum would be but a sorry | inducement and a compensation. We rejoice to recompence for what he has already done for the see Mr. Chadwick taking so just a view of these population of Liverpool, by the preparation of transactions, and we cannot but think that the the two reports on their sanatory condition.” intercourse which that gentleman has enjoyed He elsewhere shews, in reference to the

in the course of certain of his official duties proposed amount of salary, that—"For the

with such men as Dr. Duncan, by rendering him more important business of prevention-for

better acquainted with the talents, energy, and investigating and indicating the removable

devotion required for the efficient discharge of or preventible causes of sickness and mortality,

medical duties, has tended to remove some early which ravage a population of from 280,000,

| prejudices from his mind. or more, of persons, it appears that the Corpo

We shall conclude these observations with ration propose to appoint one officer only, and

one more extract from this admirable letter:to pay very little more than £1 per thousand

"It is possible, and probable, that Dr. of the persons whose general health it will

Duncan might be quite willing to perform the be his business to protect, by indicating the

services in question gratis, and even be at exgeneral arrangements requisite for that pur

pense (as he must already have been,-and I pose!”-and that the proposed expenditure to

have reason to know he has been) in performing ascertain and point out the means of averting the

them ;-but that does not alter the question or impending loss of £325 per adult individual

the pernicious character of the example. before alluded to, is "at the rate of half a

The principle set forth by Mr. Burke in his farthing per annum for each adult.”

speech on economical reform, as applicable ' "My estimate," observes Mr. Chadwick, " of to public ofices of the general governm the service requisite for the initiation of mea.

are equally applicable to such local offices sures of prevention in Liverpool was of three

as the one in question. 'I will,' he says, or four officers of health at the least, giving

even go so far as to affirm, that if men were their whole time to the service, at an expense

willing to serve in such situations without salary, of £2,200 per apnum. which, if efficiently | they ought not to be permitted to do it. Ordidirected, would be a very economical expendi

nary service must be secured by the ordinary ture, as powerfully tending to reduce the annual

motives to integrity. I do not hesitate to say charge of £18,000 for the excess of funerals

that that state which lays its foundation in the alone. But the intended compensation for the

rare and heroic virtues will be sure to have its inadequate pecuniary provision, for the services

superstructure in the basest profligacy and corof one officer, that he may take private practice,

| ruption. An honourable and fair profit is the is entirely destructive of all efficiency, even if

best security against avarice and rapacity, as in a full number of officers were appointed, and

all things else a lawful and regulated enjoyment the remuneration assigned were adequate.”

is the best security against debauchery and And again, in reference to the subject of combining private practice with the discharge of public duties:

Review. “Regular private practice not only acts constantly as an inducement to the neglect of Lectures on the Comparative Anatomy and Physiology regular public duties, but often as a severe

of the Vertebrate Animals. Delivered at the Royal penalty for the proper performance of them. In

College of Surgeons, of England, in 1844 and 1846. tracing the causes of epidemics, the officer of

1 By RICHARD Owen, F.R.S. Part 1. Fishes, health must at least occasionally find it in the

London. 8vo. pp. 308, mismanaged or neglected state of properties At no period, perhaps, has natural history, ancient owned by his patients, or by persons holding or modern, been 80 extensively and successfully local public office, persons of powerful influence, cultivated, as at the present day. The Fauna of bywho sooner or later may exert it to his pre- gone ages has been illustrated, and the science of judice."

zoology, as it now exists, elucidated by the labours of It will not fail to be observed, that the fore- |

Hanter, Curier, Buckland, Oven, Agassiz, and others. going remarks, though applied to the individual The impulse which has been given to science by the case before us, are capable of being extended to British Association, and the interesting expeditions other localities, and to other official medical which have been undertaken for scientific, purposes

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hare ondoubtedly tended to direct the public taste into is associated with a recognisable object, with some this channel; but from higher considerations, the part which may be vibrating, contracting, or pulsating importance of a knowledge of the anatomy of the in his own frame. inferior animals, and a familiarity with their babits,

| Again, “We know that it has pleased God to has been of late more fully recognised ; and there is

grant us faculties, by the right use of which we may

obtain a true knowledge of His works; and it seems reason to believe that ore long, natural history will be

part of His providence to permit certain parcels of received as a part of general, as comparative anatomy

knowledge to be thus introduced from time to time, is nor of medical, education. To our illustrious to the dissipation of the erroneous notions which precountryman, John Hunter, to the immortal Cuvier,

viously prevailed. By the exercise of these faculties, and to Owen, upon whom the mantle of Cuvier has the true shape of our spheroid was determined, and been gracefully described as having descended,'are / after some opposition, accepted; next its true relations we indebted for the most valuable discoveries in this to the sun, as repects its motion. It has been reserved department of science.

for the present generation to acquire more just ideas Independently of his other important works, the of the age of the world; and anatomy has been, and "Lectures on Comparative Anatomy," by Professor

must be, the chief and most essential means of establish. Owen, have been generally recognised as conveying the

ing this important element in the earth's history. But most raluable and profound information on that subject

anatomy aids not only the geologist, but the geographer.

By comparing the local distribution of restored extinct wbich has yet been communicated; and we hailed the

species from coeval geological strata over all the earth, appearance of tbe second volume with unmitigated

with the geographical distribution of existing animals, pleasure, which has been increased rather than dimin.

we obtain an insight into the past conditions of conished by its perusal. After a careful consideration of tinents and islands; we determine that our own island, its contents, we pronounce it to be a work which must for example, once formed part of the continent, and add greatly to the already high reputation of its author. obtain data for tracing out much greater mutations and

It will be recollected that in 1843, Mr. Owen pub. alternations of land and sea." lished a volume of lectures “On the Anatomy of the The following five lectures are devoted to a consideraInvertebrata.” Various causes delayed the appearance tion of osteological homologies, and the osteology of of the prosent volume beyond the period originally fishes. “ The great aim," says Mr. Owen, "of the intended for its publication; but we have no reason to philosophical osteologist, is to determine by natural regret that circumstance, as the Professor informs us,

characters, the natural groups of bones, of which a that “The desire to verify some of the propositions

vertebrate skeleton typically consists; and next, the

relations of individual simple bones to each other, in there enunciated, by repeating the observations on

these primary groups, and to define the general, serial, which they were founded, has led to many new dissec.

and special homologies of each bone througbout the tions and examinations of numerous specimens; and

vertebrate series.” that the utility of the present volume has been farther

The opinions brought forward by the author on this regarded, by ingrafting into the text some remarkable

sudject, bear evidence of acute observation, profound . discoveries with which the science of comparative

thought, and sound judgment; and will, we think, be anatomy has been enriched, since 1844; and by adding

found to stand the test of time. Interspersed with the details, which the time allotted to the Hunterian course

necessary detail—which is as interesting as a descripcompelled me to omit in the theatre.”

tion of bones cap bemare observations indicative of Our space will not admit of our entering into the

much sagacity, and a just appreciation of the adapta. merits of the work seriatim ; we must confine our.

tion of means to ends. selves therefore to a cursory survey of its contents.

« The predaceous sbarks are the most active and The Introductory Lecture deserves a careful perusal;

vigorous of fisbes; like the birds of prey, they and many of its passsges are full of beauty. Take

soar, as it were, in the upper regions of their atmosfor instance the following:

phere, and, without any aid from a wodified respiratory "And first permit me to dwell a little on the inesti. apparatus, devoid of an air.bladder, thoy habitually mable privilege which we enjoy in entering on our maintain themselves near the surface of the sea, professional studies, by the portal of apatomy. How by the actions of their large and muscular fins. The Fast and diversified a field of knowledge opens out gristly skeleton is in prospective harmony with this before us as we gaze from that portal? Consider what mode and sphere of life; and we shall subsequently it is that forms the subject of our essential introduc find as well marked modifications of the digestire and tory study; nothing less than the organic mechanism other systems of the shark, by which the body is of the last and hightest created product which has been rendered as light, and the space which encroaches on introduced into this planet. Contrast this, which both the muscular system as small, as might be compatible sage and poet have called the noblest study of man with those actions; besides, lightness, toughness, and kind, with the dry and unattractive preliminary elasticity are the qualities of the skeleton most essential exercises of the lawyer or the divine. Every new term to the shark. To yield to the contraction of the lateral wbich the anatomical student has to commit to memory ipflectors, and aid in the recoil, are the functions which

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