1 a lump of sugar, and this method has the | did not get any better, he was advised to come advantage of being small in bulk and easily to London. When admitted, on September carried about by the patient, so as to allow 4th, a sinus was found 14 inches deep and 1⁄2 of its being repeated as often as may be inch in diameter, on the inner side of the tibia, thought advisable. It is best to begin with below the level of the tuberosity. The walls five or six drops on sugar, every four hours, of the sinus were covered with granulations. and gradually to increase this dose to twenty No disease of bone detected. Some thickening minims. This is, for most people, the max- of the tibia on the inner aspect. Good perimum quantity, but the drug, Dr. Murrell says, sonal and family history. Drainage tube was inhas little or no toxic action, and considerably serted, and the wound dressed with iodoform. 'larger doses have been taken without the pro- On the 9th he complained of headache and duction of any untoward symptoms. pain in leg. A smaller drainage tube was substituted for the other. 12th-A piece of sponge, carefully prepared and desilicated, was cut to the exact size and inserted into the sinus. 16th-Patient is progressing favorably. There is slight pain over the inner tibial tuberosity and some discharge oozes through the sponge. October 9th-The pain on the inner side of the wound has been more severe and of a lancinating character the last two days, and there is pain at the back of the knee. No appearance of granulations in the sponge. 12th Pain is less to-day; wound is dressed daily. 17th-A little discharge to-day just above the wound. No granulations have appeared in the sponge as yet. 20th-The wound continues to discharge a little, it is dressed daily with boracic lint. Patient has not complained so much of pain, for the last few days, except just above the wound. 24th-Pain less than last week. No appearance of granulations in sponge. November 3d-No granulations in sponge. Patient discharged, to attend twice a week. Chemically, terebene, C10 H16, is derived from oil of turpentine, either by the action of one part of concentrated sulphuric acid on twenty of the oil, and subsequent distillation, or by one of the other processes known to chemists. When terebene is submitted to the action of dry hydrochloric acid gas, a white crystalline mass results, the hydrochlorate of terebene, commonly known as turpentine camphor, or terpine, which resembles ordinary camphor, and has also been employed in the treatment of the same class of complaints as terebene. Some difficulty was experienced in obtaining an adequate supply of the pure drug when first brought forward, and attempts were made to pass off one or more patent preparations on the public as the only pure terebene, but it is to be hoped without much success. HOSPITAL REPORTS. Epithelioma of Tongue; Removal; Septic Pneumonia; Death.-Fred. P, æt. 49, CHARING CROSS HOSPITAL. fishmonger, applied, on July 15th, with a hard UNDER MR. J. ASTLEY BLOXAM, F.R.C.S. Necrosis of Tibia; Sponge Grafting.Michael B, æt. 24, laborer, was thrown from a horse six years ago, falling on his hands and striking his knee against a sharp stone, causing a bruise with pain. This was followed by swelling of the leg, extending from a little above the knee to half way down the leg. He was told that he had a dislocation of the patella, and was treated for this during six months, when the swelling went away and he felt all right except for a sharp, throbbing pain which he had at intervals. Twelve months ago he had a swelling, with great pain, over the site of his present sore, into which an incision was made, giving exit to a quantity of pus. As he nodulated mass on the left side of the tongue, side, and then removed the diseased half of the tongue by cutting through the median line with scissors and crushing through the base with the écraseur. There was not much hemorrhage. The sub-maxillary gland was removed at the same time. Patient had a disturbed night, notwithstanding mxxx of tinct. opii. 22d-Patient was fed with an oesophageal tube, owing to the difficulty he had in swallowing food. His throat was mopped out every hour with a sponge. Later in the day the breathing became embarrassed with a troublesome cough. Slight elevation of temperature. 23d-Patient seemed a little brighter in the morning. He was unable to take food in the usual way. He was ordered an enema, which cleared out the bowels, to be followed by an nutrient enemata every four hours, with four ounces of Port-wine. Marked dulness at base of right lung. 24thPatient is much weaker. Dulness at base of lung increased. Respiration 38. Pulse 128. He sank and died at 1.46 A.M. Case of Chronic Strumous Disease of the Knee-joint; Amputation; Recovery.-William T-, æt. 16, errand boy, was admitted on January 7th for disease of the right knee, which was much swollen, and discharged pus from the site of an old incision on the inner side of the joint. Patient was in the hospital a year ago for the same cause, when a large quantity of pus was evacuated by means of free incisions on the inner and outer side of the joint. He apparently recovered, after a stay of some months in the hospital, and resumed his occupation of errand boy for some time without any untoward result. Early in the present month he noticed a swelling on the inner side of the joint, where one of the incisions had been previously made. Patient's general health is poor and he is thin and pale, but there is no evidence of phthisis. His father died of "bronchitis," but the rest of the family are alive and well. There is no albumen in the urine, but he sweats a good deal at night. Patient was put on a liberal diet and tonics, and the limb was put on a McIntyre's splint. He passes restless nights and complains of a good deal of pain. His evening temperature averages 103.2° Fahr. As several fresh openings formed, and the joint appeared thoroughly disorganized, on February 24th Mr. Bloxam removed the leg above the knee (patient being under ether) by a combination of the flap and circular methods. Both the flaps were taken from the skin and the bone and muscles divided circularly about a hand's-breadth above the knee. After division there was great retraction of the soft parts about the bone, and the periosteum was accordingly reflected and another inch of the bone removed. The vessels being ligatured, the flaps were stitched together and the wound dressed antiseptically. On examination of the limb it was found that the seat of the disease was in the synovial membrane, which was greatly thickened and infiltrated with pus. The bony surfaces were comparatively healthy. 25th-Patient was unable to pass his urine, and five or six ounces were drawn off by means of a catheter. Temperature 100 Fahr. March 4th-Stump looks well, but owing to retraction of soft parts, the bone is pressing against the anterior flap and some of the sutures have parted. The flaps were brought together with isinglass plaster and the wound dressed. The boy's general condition is much improved. He has gained in weight, and his temperature is normal. The stump was completely healed by April 12th, and on the 20th patient was able to leave the hospital. Case of Coccydynia; Operation.-Emma C-, æt. 21, domestic, fell down stairs about fourteen months ago, but says she felt no inconvenience for two or three months, when she noticed a hard lump forming in the соссуgeal region, which rendered her unable to sit down. Patient had an abscess in the right gluteal region, about a year since, but it soon healed up. On examination per rectum, the coccyx seemed rather thrust forward, movable and very painful, but the last was the only really noticeable symptom. Patient says she has pain sometimes on passing; a motion of a throbbing and shooting character. She was ordered glycerine and belladonna, to be rubbed over the painful site twice a day, and this afforded her a good deal of relief for a time. As the pain did not, however, disappear, she was put under ether, on February 1st, and the structures around the coccyx were divided by Mr. Bloxam. The patient felt weak after the operation, but as soon as the effect had passed off, she said she felt much better. The old throbbing pain had gone, and there only remained a little pain at the seat of the operation. The incision was dressed the following day and touched with nitrate of silver. 23d—A small fissure was discovered at the orifice of the anus, which was touched with nitrate of silver. March 3d | Last July the pain became more marked and Pain almost gone; patient was discharged to a convalescent home. Suppuration in Antrum from Carious Teeth. -Amelia B—, æt. 22, dressmaker, complained of a swelling over the right superior maxillary bone. It does not infringe on the orbit or nose. Patient appears to have had a small abscess in the same situation when fourteen years of age, which left some induration after it. This remained stationary until about six months ago, when it began to increase in size. The present swelling is smaller than it was some time since, when, as she says, it seemed to push the eyeball back. On looking into the mouth, the two upper bicuspids on the right side were found to be much decayed. Patient says she has never had any discharge into the mouth or nose, but last Sunday, for the first time, a little blood welled up into the inner canthus of the right eye. The following day Mr. Bloxam examined the patient, under chloroform, and found that the tumor was connected with the antrum. The carious teeth were removed and about an ounce of watery pus drained away. The antrum was washed out by injecting a weak solution of permanganate of potash, and this was continued for a day or two. The swelling disappeared, and patient left the hospital, cured, on the eighth day after admission. Bulbous Nerve Ends in Old Stump of Leg. —Alice D—, æt. 23, seamstress, was sent to the hospital to be treated for a painful stump, left after removal of the leg sixteen months ago on account of gangrene following a wound of the big toe. It is a very good stump, a little red at the margin of the cicatrix but no sinuses are present. There are two painful spots on the anterior flap. Mr. Whitehead dissected down on the anterior seat of pain under antiseptic precautions, and cut away a piece of tissue which comprised a nerve bulb of some size. The edges of the incision were brought together by strapping, and dressed with red lotion. Patient says she has no longer any pain in the stump, but complains of pain in her right leg. The wound suppurated a little but eventually healed up and patient left the hospital relieved. Perimetritis followed by Suppuration. Rose C, æt. 18, buttonmaker, admitted April 5th. Patient says that as a child she was subject to attacks of pain in the side and spasms. persistent and a lump formed in the groin, which was poulticed and suppurated. It closed after a time but had to be reopened. Patient menstruates regularly, but has suffered for years from dysmenorrhoea, with pain of a bearingdown character. She has noticed that when the discharge from the wound ceases, she gets leucorrhoea. She has no pain on moving the hip, nor on tapping the foot, and walking is not much interfered with. Patient is pale and delicate looking. There is no pain in the back or other indication of any affection of the vertebræ. She starts a good deal during sleep and perspires abundantly at night. On examining the wound in the groin, a sinus was found at about the middle of Poupart's ligament which may be traced for a considerable distance backwards. Temperature 103° Fahr. Pulse 130. April 11th-Patient was examined by Dr. Black, who found traces of perimetritis with adhesion of uterus and left ovary. 26th-Patient seems better, the depth of the wound is decreasing and the discharge is slight. She still complains of a burning pain in left groin. 29th-On probing wound with a portion of catheter a considerable quantity of grumous pus escaped. May 2d--Patient complains of much pain, extending to the iliac region, which prevents her sleeping. A piece of drainage tube, five inches long, with thread, which was placed in the wound, unaccountably disappeared, and is supposed to be in the wound. 8th-The drainage tube has been left out of the wound for three days and it has healed over. There are, however, indications of accumulation of pus, and patient says she has a great deal of pain on micturition and defecation. The temperature oscillates between 98°-102° Fahr. The tongue is coated and the skin is dry. She has not menstruated since admission (a month), though previously she did so every two or three weeks. On probing the wound a large quantity of greenish pus escaped. 11th--Patient was placed under chloroform and digital exploration was made of the wound. The sinus could be traced in an upward direction towards spinal column, and a large quantity of pus was evacuated. No abnormal growth was discovered, nor was the missing tube found. tube found. A large size drainage tube was inserted and poultices constantly applied. 19th-The discharge is free, but patient says she is comparatively free from pain and on the Urinary Fistula and Cellulitis of Scrotum.—Henry B—, æt. 48, domestic, was admitted in November, 1879, under Mr. Barwell, for stricture of the urethra, and was treated by rapid dilatation, leaving the hospital, much relieved, three months later. He had a chancre twenty years ago, and gonorrhoea since. He then went abroad, where he was again troubled by retention of urine. In October, 1880, he first noticed a hard swelling in the perineum, which he described as very painful. It rapidly increased in size, and in December of the same year he applied at a hospital for relief. He was given an ointment, but it did not get any better, and on January 7, 1881, he was admitted as an in-patient. He was then told that it was an abscess, and was ordered warm hip baths and poultices. On the fifth day after admission it burst, and there resulted two patulous openings which could not be induced to heal. The two were converted into one with the knife, in the hope of getting them to close. Eleven days ago his scrotum began to swell, and, being very painful, he was sent over to London to be treated. When admitted, on March 19th, the whole scrotum was enormously swollen, tense, and cedematous. The edges of the wound were indurated and everted. There whole much better. She is on a liberal diet, | A further incision on the left side of the with five ounces of wine daily. 26th-The scrotum did not give exit to any pus. May abdomen, on the left side, feels tense and some- 7th-Mr. Grindon succeeded in passing a No. what hard and is painful on pressure. August 5 elastic catheter to-day. 14th-The edges of Ist-The patient's condition has remained the fistula are less indurated, but there is more about the same. She has been allowed to get oedema of the scrotum. A No. 3 silver catheup for a few hours daily, and takes her food ter was passed to-day. 19th-A longitudinal pretty well. September-Patient has gained incision was made over the anterior part of the in flesh and is much better; very little pain scrotum, which was frozen by the ether spray, or discharge now. She was discharged to a a small quantity of pus exuded, and a poultice convalescent home in October. was applied. 26th-No. 4 silver catheter passed to-day. 27th-The patient had a rigor to-day on a No. 4 catheter being passed. Another abscess is forming on the under aspect of the scrotum, on the left side, which was incised on June 2d. Very little urine escapes by the fistula. Several other abscesses formed in different places on the left side of the scrotum. 18th-Mr. Bloxam succeeded in passing a No. 6 silver catheter to day: July 23d-To-day a No. 8 silver catheter was introduced. There is still a good deal of discharge from fistula, but the patient's general health has greatly improved. August 6th-No. 9 silver catheter was passed to-day, followed by a gum elastic instrument to be left in for two hours. September 6th-Patient passes about thirteen ounces of urine, without any escaping by the fistula, which is disposed to close. The strictures are still very tight. October 6th-Today, internal urethrotomy was performed. 10th-Patient has no pain, and can pass his water freely, none escaping by the fistula. 18th-Patient is unable to retain his urine well, but this improved under iron and strychnia. There is still some discharge of pus, mixed with blood, from the scrotum, and a little urine comes away occasionally through the opening in the scrotum. November 2dPatient complains of pain on defecation, No. 22 bougie passed easily, but No. 24 was firmly gripped. 18th-A little pus still discharges from the sinus, which runs up for some two and a half inches towards the urethra. No. 24 bougie passed without much difficulty. 21stA little nitrate of silver was introduced into the sinus on a probe. December 7th-A little urine comes through the fistula when the patient passes his water in bed, but a great deal comes through when he micturates standing. He left the hospital on the 15th much improved in health, but with the sinus unclosed. was no distention of the bladder nor swelling of the parts beyond the abdominal rings. Temperature high, pulse rapid, tongue glazed. The parts were punctured with a needle, and ordered to be poulticed. 23d-Scrotum is much diminished in size, and his general condition is much improved. Fluctuation could be plainly felt in the front of the scrotum, and on making an incision a large escape of blood and pus took place. He was put on tonics, and ordered charcoal poultices. Temperature, 101° Fahr. 25th-The scrotum is decreasing in size, but a good deal of pus and blood continue to drain away. 30th-Patient complains that the urine trickles out through the incision in the scrotum. Pelvic Abscess.-Alice W-, æt. 22, governess, was admitted on January 12th. There epididymis and cord, however, not sharing in the enlargement. He had two ulcers on the inner side of the left leg, and one on the outer shape, with a raw beef colored induration surrounding an elevated seat. He had a chancre with the usual sequelæ some years ago. Patient states that nine months ago he noticed a swelling of the right testicle, followed six weeks later by a similar increase of size of the left testicle. This slowly increased until was a history of her having had pleurisy five | with both testicles symmetrically enlarged, the years ago. A swelling appeared in the left groin directly after, which ultimately burst, with a free discharge of pus lasting some weeks and then ceasing. Two years later, however, it re-side of the right thigh. They are circular in appeared again for a month. In April last the discharge appeared once more, and has continued off and on ever since. Appetite is bad, and the pains in the pelvis interfere with sleep. The bowels are confined, catamenia regular. On examination a fistulous opening, with everted edges, was found one inch below the anterior superior iliac spine, on the left side, which ap- | six months ago, when they attained the size of pears to be discharging freely. A tent was placed in the wound. 15th-On removal of the tent to-day, a quantity of putrid pus escaped; the wound was syringed with carbolic lotion. 25th-Mr. Bloxam explored the sinus to-day, and made an incision between the last rib and the crest of the ilium, and passed a drainage tube through this incision and out of the wound in the groin. No albumen in urine. Temperature rose to 103.2° Fahr. this morning. 30th-Temperature, 97.4° Fahr.; not much pain, free discharge from the incision, patient sleeps well. Poultices are being applied February 27th. Temperature keeps down, and patient's general health is improved. Drainage tube has been removed. March 13th -Poultices were ordered to be discontinued, as the wound seems to be healing up satisfactorily, and there is very little discharge. 15th -Wounds are now completely healed, and patient was allowed to get up, and was discharged a few days later (March 21st). April 4th-Patient was readmitted to-day. Cicatrix in lumbar region having reopened, and is discharging slightly. The probe was introduced, but only passed a short distance. 21st-The wound has quite healed, and all discharge has ceased, but patient complains of feeling sick, with pain over the region of the cæcum. Temperature 102° Fahr. As bowels have not acted, she was ordered 3iss of castor oil, with mxv of tincture opii. 23d-The sickness has continued, as also the pain. Temperature 102° Fahr. The old incision was opened up afresh, and about an ounce of pus escaped, with great relief to the patient. Poultices ordered. 27th-Wound has again healed. Patient was discharged, and was ordered to take quinine mixture and cod liver oil. Case of Syphilitic Sarcocele.-George L-, æt. 24, sailor, was admitted on October 18th, an average melon. As he experienced no pain and but little inconvenience, he followed no treatment. They then became somewhat less swollen, and latterly have remained stationary. He was put on fifteen grain doses of iodide of potassium, with half drachm doses of liquor hydrarg. perchlor., in an ounce of decoction cinchonæ, three times a day, together with two and a half grains of blue pill, and one quarter grain of pulverized opii at bedtime. The pill was subsequently discontinued, and a drachm of mercury ointment was ordered to be rubbed into the scrotum every night. 23d -The testicles are reduced to about half their former size. Patient complains of pain in the left side. 24th-The left testicle is smaller and harder than the right. Patient's gums are beginning to get sore, so the liquor hydrarg.. was discontinued. 26th-He is now fully under the influence of mercury, and the inunction was temporarily suspended. The testicles are very much smaller, and on the 27th patient was discharged to attend as an out-patient. Cystic Disease of the Left Breast.-Annie I, æt. 29, stationer. Patient first noticed a swelling in her left breast about seven years ago. She had diphtheria about six months before the swelling was first remarked. Since that time it has increased somewhat in size. She went to St. Thomas's Hospital two years ago to have it removed, but they refused to operate. There was nothing of interest in the family history. Patient is well-nourished, and of very dark complexion. She says she has been losing flesh the last few months, and suffers a good deal from indigestion. On inspection a slight bulging of the left breast was seen just over the third rib. On palpation a hard mass can be felt at the upper and outer part of the gland; irregular in shape, nodulated, very hard. freely movable on the subjacent tissues, and the |
