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the pulse was quick and hard; the pa-tient was restless and thirsty. She was

evidently much worse since her admis-sion, and the ulcer had considerably ex-ended. It was ascertained from herfriends that the unfortunate wretch hadbeen much accustomed to the pernicioushabit of spirit drinking, to an amazingextent. Mr. Green directed her to bebtedto the amount of twelve ounces, andto take the saline effervescing mixture.(The bowels-had been previously wellopened by the house medicine.) l.inseedpouttice, with poppy fomentation, to be

- applied to the ulcer.Oct. 6th, Thepain and irritation in the

sore had- been relieved by the venesec-tion ; but it was still pursuing its destruc-tive course. Pulse very quick, and de-noting irritation. The blood was not

buffed, but it was firmly coagulated. Thesaline mixture was directed to be continned every four hours, with the additionof five ininims of laudanum.

Oct. 7 tli. The sore increasing, edge less,defined; the patient complains of much

I

pain, and is very restless. The undilutednitric acid was ordered to be applied tothe ulcer, and to be repeated on the fol-lowing day. One grain of opium to betaken at night.

Oct. 10th. The sloughs occasioned bythe nitric acid, are separating; but thereis no appearance of granulations. Thereis a broad -line of dark-coloured inflam-mation extending into each groin. Theconstitutional symptoms continue. One

grain ot opium to be taken three times adav.

i4th. No improvement either in consti-tutional or local symptoms. The acid wasagain applied to day, and she now uses,as a constant application, the nitric acidlotion, which is made by adding fitty dropsof the strong acid to a pint of water.

20th. The sore is now of the size of alarge hand, extending down the whole ofthe labia, which are, in fact, destroyed.The inner surface of the sar is verydark and sloughy, the acid has beenapplied once since the last report. The

pulse is very quick, conntenance anxious,and teeth somewhat covered with sordes;the tongue brown and dry in the centre,but clammy and moist at the edges. She wa.’.directed, yesterday, four ounces of gin tobe taken daily, and ’one pint of porterwith a mutton chop. She now takes one

grain of opium every six hours.22d. The destructive process of nlcera-

tion proceeds uncontrolled, and it is nowtruly an appaliing sight. A foul un-healthy looking ulcer, occupying the entirelower part of the abdomen, of consider-able depth, and even extending into the,

abdominal muscles. She was directed totake

Sulphate of quinirte, 2 gl’ains ; ,

Capsicum, S grains, every six ))om9and to continue also the opium.

27th. Nature can no longer Withstandthe ravages which have been going on,and we find the poor woman to-day evi.dently sinking. We learn that she linger-ed on until the following evening. Thenitric acid was applied five times to the

ulcer, but it had no effect in checking thedisease.

ST. BARTHOLOMEW’S HOSPITAL

Emphysenta.William Willen, aetat. 7, was admitted

into Rahere’s Ward, under Mr. Vincent,on Monday October 18th, having beenknocked down and run over by a hackneycoach. Upon examination, two of the infe-rior ribs on the right side were found frac-tured,and their fractured ends having beenpushed illwal d, through the intercostalmtiscleq, pleura costalis and pulmonalis,into the substance of the lungs, the airhad consequently escaped into the thorax,through the pteura and taceratedmusde.s,into the cellular tissue, on the outside ofthe chest ; and thence diffused itself overthe lead, neck, shoulders and breast ; so

as to inflate the parts in a mostextraordi.nal decree. The patient complained ofa comiderable tightness of the chest, withpain chiefly in the situation of the trac.-

ture ; he had difficulty of breathing, uliieliincreased in proportion as the skin be-came elevated and tense ; it was laboriotsas well as frequent. His inspiration wasshort and rapid, and ended with a kindof catch in the throat. When he spoke,his voice was similar to that of a ventri.loquist ; or indeed, more like to that of

the far-famed Punch ; it was small andsepulchral, and seemed to come from theabdomen. The countenance was red andswollen, the eye-lids nearly closed; thepulse, at first weak and contracted, after.Wtt’ds became irregular. On pl.lcingthehand on the integuments, they had an

el.a.,,tic feel, together with crepitationsimijai’ to the noise from handling a dry ybladder half filled with air. In additionto these symptoms lie had cough—bring-ing up after 1U,.ny ineffectual efforts a

frothy discharge, slightly tinctured withblood. Mr. Vincent was at the Hospitalwhen the boy was brought in, and orderedhim to be put to bed as soon as possible,

and a bandage to be applied, but did not,in our hearing, order vet.eseetion. The

child had been four hours in the Hospital,

271

labouring under extreme difficulty of

breathing, when Mr. Stanley accidentally ,,

saw him, and directed immediately V. S.to x.; the patient felt greatly relieved,from the loss of blood, but during thenight, as the pulse again became quick anddifficulty of respiration returned, he wasagain bled to gviij. and an active aperientadministered.

.

l9th. Much relieved ; but the emphy-sema being still considerable, he was bledagain to-day to x. and actively purged ;complaining of pain in the abdomen, 12leeches were applied.

20th. To-day is much better; the em-physema is greatly diminished. Fromthis time the boy has done well, and wilishortly be discharged.This case has been attended with a very

different result from the one last admittedinto the Hospital, and in which puncturewas considered of such vital consequence.

MIDDLESEX HOSPITAL.

Operation of Lithotomy which proved fatalfrom Hæmorrhage.

John Fletcher, a?t. 57, a robust healthylooking countryman, was admitted intothe Hospital August 2nd, under the careof Mr. John Shaw, with symptoms ofstone in the bladder. He was sounded

about a week after his admission, and astone was readily felt, to the satisfactionof Mr. John Shaw and Mr. Joberns.Palliative remedies were administered du-

ring a period of eight weeks, that is untilthe 29th of September, on which day thefatal operation was performed. Wevisited the patient frequently previous tothe operation, and he as often complainedof his state of extreme suffering; dayafter day did the poor man reiterate hiscomplaints, and beg that he might berelieved by an operation. But Mr. Shawhad reasons tor allowing the man to con-tinue in this state of suffering, which weshall presently explain.The operation was performed in the

following manner, on Friday Sept. 29th.Mr. Shaw introduced his finger into therectum, and made his incision in theperienæum with a scalpel; the point of thescalpel was placed in the groove of thestaff and carried on. Whilst cuttingthrough the prostate gland, there was aprofnse gush of blood, which appearedto be principally arterial. Mr. Shawafterwards used a curved bistoury to en-large the opening in the biadder. The

forceps were passed into the biadder,and two small flattened calculi werereadily extracted, of an oval shape.

It appeared to us that upwards of three

pints of blood were lost during the ope-ration. The patient was put to bed, andthe hæmorrhage continued. Cold wetcloths were applied over the thighs

: and _ ;abdomen. Mr. Shaw attempted todiscover the bleeding vessel, but couldnot; and he says- that pressure upon theinternal pudic artery did not restrain thehæmorrhage. Durit.g several hours thebleeding continued profusely, but towardsthe. evening it abated; the patient wasnow greatly exhausted, and the loss ofvital fluid had been so great, that it wasappatent that death must ensue. Therewere spasmodic twitchings and greatrestlessness; pain in the abdomen, withpallid collapsed features, and cold ex-tremities. The poor man died about11 o’clock, being a lapse of ten hoursfrom the performance of the operation.Some brandy was administered at inter-vats’durinT the evening.The body was examined by Mr. John

Shaw, and the arteries injected. The in.

jected preparation was shown to the pu-pils on the t’ollowing morning. Mr. Shawinformed the young gentlemen, that therewas an irregular distribution of the arte-ries, and that one of the branches of theinternal pudic artery, (the artery of thebulb,) was given off very high up, andthat it crossed over the neck of the blad.der, so that it was impossible to avoid cut-ting it.-Fud;e! The artery which hadbeen divided appeared, to our mortal

eyes, to be the internal pudic ; but the ma-noeuvre of privately examining the body,and bringing up an injected preparation,prevented us from being fully satisfiedon this point. We must, ’;however, ex-plicitly state, that we do not believe oneword of Mr. John Shaw’s explanation.

In performing the operation of litho-tomy, there are only two vessels of con-sequence which can be wounded, or fromwhich any danger from haemorrhage canresult, these are the artery of the bulb,and the internal pudic artery. (The in-ternal iliac might be wounded by JoeBurns.) Every body knows, or, at least,every body ought to know, (because ithas been advertised and puffed in everyjournal of the kingdom,) that Mr. JohnShaw has written a Manual of Anatomy,in which work he has been pleased to besomewhat critical upon the operation oflithotomy. Mr. Shaw’s observations are,of course, purely speculative, because wehave reason to believe that he had never

performed the operation on the livingsubject, until he operated on the poorman whose case we have just given. Butas Mr. Sliaw has taken oonsidet able paiusto " write hintseif down an ass," out ofhis own mouth we vrill judge him.