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limb, and specially on the distinct tumours, varying its position and degree as appearance indicated. The latter part of this treatinent required caution, as also a prolonged interval between the periods of iis imployment; for, even when inconsiderable, it soon caused no slight augmentation of the patient's sufferings. Most relief appeared to be derived from cold applications to the limb.

At the expiration of somewhat more than two months, the patient, at her own request, left hospital, having apparently derived but little benefit froin its treatment.--Dublin Quarterly Journal.

A Case of Enlargement of the Thyroid Gland, treated by Seton. By Henry Kennedy, M. B.--In November, 1845, a woman, aged 35, applied to me on account of an enlarged thyroid gland. She had been married nine years, and had four children; she has lived of late years in Dublin, and has always been healthy in every respect excepting the disease she applied about. The gland had begun to

. enlarge so far back as the year 1832, thirteen years before my seeing her. At first it had increased very slowly; but the last year or so, she said, it grew more rapidly. When I saw it the lumour was at least the size of the largest orange; it was very hard to the touch, as if it were solid, but was divided into two portions, of which that on the right side was much the largest; it did not vary in size at the menstrual periods. It was not, however, on account of the bulk of the lumour, for that respect there was nothing remarkable, that the patient applied for relief, but because it had affected her swallowing from a very early stage of its growth ; and this symptom had latterly become much more distressing : solids were more difficult to get down than fluids, as might be expected. She referred the obstruction to the seat of the tumour. She told me she had shown it to other medical men, but she considered it still increasing. I ascertained that iodine had lately been used, both internally and externally for some weeks.

Under all the circumstances of the case, the tumour and dysphagia on the increase, and iodine having got a full trial, I determined on soine more decided line of treatment, the more readily as the patient herself was most anxious that something should be done. The plan by seton seemed to hold out the best prospect of success, and it was carried into effect, having previously brought the general health into the best condition. The first seton was passed on the 30th of November, 1845. A common curved needle of the largest size, with its eye nearly full of doubled silk thread, was passed from below directly upwards, through the anterior portion of the tumour, about half an inch from the iniddle line of the neck, and including a space of at least one inch and a quarter between the entrance and exit of the seton. This was then fixed so as to prevent its slipping out, and the patient was desired to keep a poultice constantly applied, and also to keep her bed for two days; no bad effects followed. It is enough to state here that this first seton was withdrawn in ten days; that at the end of a fortnight a second one was passed; that it was double the size of the first, and its introduction was followed by a very considerable degree of constitutional iritation, which, however, subsided in about four days; suppuration then became very fully established, and the second seton was withdrawn, after being in twelve days. With the exception of poulticing, nothing was done during ihe next four months. In this time considerable changes had taken place in all the anterior portion of the tumour, and that part of it which occupied the left side ; it had become very hard, and gradually, but steadily, diminished in size. The larger portion of the tumour, however, occu. pying the right side of the neck, remained stationary. It appeared, indeed, as if it had grown somewhat larger; but this was not certain. A third and last seton was passed through this portion of the tumour in the month of April, 1846 ; its direction was upwards and ou:wards, so as to take in the longer axis of the swelling. This seton was four times larger than the previous one; it was passed with a large packing-needle, with the edges and point properly ground. After sixteen days the seton was withdrawn, the suppuration being then very considerable. Finally, after four months more, the entire tumour had so much lessened, that it might be considered as cured. The entire process occupied between eight and nine months.

At the present time (January, 1847), the eye cannot detect any tumour, but to the touch one remains, which is probably the size of a small chesnut. There is no deformity whatever, and very trilling marks of where the setons had been passed. The patient, too, feels no difficulty of swallowing, at least none that causes any inconvenience,

As I wish here to confine myself merely to the facts of this case, I have purposely omitted the consideration of several points which might fairly admit of discussion ; such as the nature of the tumour; the question of a more general use of this plan, after the more ordinary means have failed, particularly iodine ; the nature of the dysphagia, as to whether it was nervous or mechanical; the causes of those enlargements, and other points connected with the subject in a general way. It is to Quadri, of Naples that we are indebted for the plan of treatment put in force in the present case. Not being certain of what the result of the treatment would here be, I did not take the precaution of getting a cast of the tumour when it was of large size. This, probably, is of less consequence, as the patient has been seen by several gentlemen, to whom I may here refer. Dr. Clarke, of Herbert-street, saw her repeatedly; he look much interest in the case, and kindly gave me his assistance. At a late stage, and after all the setons were withdrawn, the patient was seen by several physicians and surgeons of this city.--Ibid.

Poisoning by Sulphuric Acid.-On Monday, Dec. 29th, 1845, a boy, aged 9, was admitted into the London Hospital, under Dr. Little, suffering from the effects of oil of vitriol. He was at play in the street, when a strange boy give him a teaspoonful of it to drink; he swallowed about an ounce of the acid, and was instapıly seized with excruciating pains in his throat and stomach. He ran home, and,


according to his father's account, looked as if somebody had been smearing his lips with white paint. He was carried as quickly as pos. sible to a neighbouring surgeon, who administered a great quantity of chalk and magnesia; five minutes, however, must have elapsed before anything was done. His father then brought him to the hospital, and he becaine very sick, throwing up a quantity of brownish matter, from which the chalk readily subsided, leaving a supernataut liquor, strongly resembling porter; it was chiefly mucous, charred by the sulphuric acid. He appeared to be suffering a great deal, the countenance was anxious and deadly pale, the extremities cold, and the pulse scarcely perceptible. Under active treatment he rallied, and in about seven hours fell into a quiet sleep, he passed a very com: fortable night, and got out of bed iwice to void his urine. In the morning, the countenance still looked anxious; he complained of pain in his throat and stomach, though it was not increased by pressure; the lips were swollen, and surrounded by reddish brown scabs, the effects of the acid; the tongue also was covered with a pearlywhite epithelium, which had already begun to peel off from its sides, the skin was hot and dry; the pulse one hundred and thirty-two, hard and jerking.

He was ordered albuminous food, and two leeches were applied over the top of the sternum. This febrile condition lasted for four days, the skin remaining hot and dry, and the pulse quick and jerking; during this time he was copiously salivated, and he spat up a great deal of white, shreddy epithelium; the urine was high coloured and increased in quantity, while the bowels remained obstinately constipated. On the fifth day an active purgative relieved them, and from that time he gradually got well

. The urine which he voided during the first four days of his illness was submitted to chemical analysis. Its quantity was greater than natural; it had a deep red colour, a strong acid reaction, and a specific gravity varying from 1046 to 1030; it did not contain the least trace of albumen, but held so much of the triple phosphates in solution; that on neutralizing with ammonia they were thrown down in the form of a copious white precipitate. On testing for sulphuric acid, there was found, on the first day, a quantity equal to sixty-two grains of the strongest oil of vitriol; on the second day, forty grains; on the third day, 18.3 grains, and on the fourth the equivalent of 12.7 grains. The urine was not examined on the following day, but on the sixth it had again become natural. In all, therefore, 133 grains of monohydrated sulphuric acid were thus got rid of a quantity which is about equal to an ounce and three-quarters of the dilute acid of the London Phar. macopeia.

The case offers the following peculiarities:

1. That he should have recovered after the poison had remained so long in the stomach.

2. I:s detection in the urine shows that the acid had been absorbed.

3. Its action was almost entirely local, the only constitutional symptoms being a little fever with copious diuresis.

4. That the duty of getting rid of the poison rested with the kidneys.

5. That as much as, or rather the equivalent of, 133 grains of the strongest oil of vitriol should be permitted to circulate with the blood of a child nine years old without producing any very dangerous consequences.-Lond. Med. Gaz.

Polypus of the Rectum. By Mr. SYME.—Sir A. Cooper states, in his Surgical Lectures, that " in the course of his life,” he met with only ten cases of polypus of the rectum.

Some time ago, I met with five cases in the course of a single fortnight--two of them in adults, and three in children--and I have seen a sufficient number of other instances of the disease, to satisfy me that it is not by any means so rare as has generally been supposed. It presents itself in three different forms, of which one usually occurs in childhood, and does not appear much beyond puberty. A gentle. man now established in practice, not far from Edinburg, when attending my lectures--then I suppose about eighteen or nineteen years of age--applied to me for the removal of a polypus, such as is met with in early life; with this exception, I never met with it beyond the ninth or tenth year.

It is extremely soft vascular, of a florid red colour, and assumes the forın either of a worm from two to four inches in length, or of a strawberry with a connecting footstalk two or three inches long. This tumor seldom protrudes except when the bowels are evacuated, and then admits of ready replacement, although not without occasional hæmorrhage, which may be of considerable amount. The vascularity of this growth, and its attachment above the sphincter, * made me averse from removing it by excision ; and Sir A. Cooper has mentioned the alarm that was on one occasion excited in his practice by doing so. I have always employed the ligature; and though the soft structure readily gives way when the thread is drawn, bleeding has never occurred in a single instance, or any other symptom in the least degree disagreeable resulting from this mode of removal; I am therefore induced to regard it as the best that can be employed.

The disease appears in adults in two very distinct forms. In one of these, the growth is soft, vascular, prone to bleed. lobulated or shreddy, and malignant-looking, so as on the whole to resemble very much the cauliflower excrescence of the os uteri, but possesses a peduncle or foot stalk of firm texture, capable of sound cicatrization after being divided. The profuse, frequent, and protracted bleeding which proceeds from this sort of growth, renders its removal an object of great consequence; and this may be effected very easily, and with perfect-safety, by transfixing the radical cord of connexion with a double ligature, tying the threads so as to include a half of it in each, and then cutting it across a little below the constricted part. tient of Mr. Craig of Ratho,(who detected the disease from the great hæmorrhage it occasioned,) ì could not accomplish protusion of the lumor, but guided a ligature on my finger, and tied it on the neck within the rectum. It is more satisfactory to force or draw the swel.

In a pa


ling beyond the sphincter, so that the sound and morbid parts may be distinguished with certainty, and this can usually be done with great facility, although the growth has attained a large size. In a hospital case recommended by Mr. Anderson of Castle-Douglass, I brought into view and removed a tumor not less than an orange, which had a most malignant aspect, and had nearly exhausted the patient by hæmorrhage.

In the other form which polypus of the rectum assumes in adults, the tumor is of a firmer consistence, smoother surface, and more regio larly spherical or oval form, so as to resemble the growth which in general constitutes polypus uteri. The symptoms resulting from this simple swelling are rather annoying than seriously alarming; and the patient, therefore, is apt to delay requiring assistance for a long while. In the case of an old lady, whom I saw with Mr. Flilson of Jedburgh, the tumor was about the size of a cherry, with a long stalk, and we were assured had protruded every time the bowels moved for twenty years. In another case, a gentleman whom I saw with Dr. Johnston of Cumnock, the tumor was nearly as large as an egg, had a cuticular covering, and appeared to have existed for a period equally long. I have always removed these growths in the way that has been already described, and never met with the slightest consequence of a disagreeable kind.-Lond. and Ed. Month. Jour. of Med. Science.


Pain in the Side, in thoracic inflammations, generally corresponds, according to the indication of the patient, not to the precise point of the organ affected, but to one a little below it,—that is, the painful sensation experienced is in a situation inferior to the lesion.' When local evacuations of blood, therefore, are ordered, or blisters, they should be directed to be applied a little higher than the painful part(Rostan.) This precision is not without importance in certain cases, for it may happen that, following the indication of the patient, remedies are often applied to the abdomen, when the disease is at the lower part of the chest.-Ibid.

Sugar in the fluid of Ascites in a Diabetic patient... In the fluid from the abdomen of a diabetic patient who was attacked with ascites, Dr. Landerer detected evident iraces of the presence of sugar. The existence of this substance is almost all the secreted fluids in the body of persons affected with diabetes has now been proved.--Heller's Archiv.

Operation of Gastronomy for the Relief of Internal Strangulation.We are informed that the operation of gastronomy has been recently performed by Mr. Hilton, of Guy's Hospital, with complete relief to ihe intestinal obstruction, in a man, tiventy years of age, suffering from internal strangulation of a large portion of ileum of twelve days' duration. The point of obstruction was situated about twelve inches from the cæcum. The patient died of exhaustion a few hours after

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