a blister failed to act, had but a short time to live. The blister did not act, and the patient concluded that his only method was now to commit suicide, to prevent the misery of a lingering death. He therefore put himself to death with one of the loaded pistols which hung at his bed-head! Before making any reflections, we shall present the post-mortem appearances. The head was not opened a most culpable omission under such circumstances. The right lung was nearly hepatized, and in its upper portion was found an excavation, capable of containing a very large nut, and communicating with several of the bronchia. There were false membranes in several places on this side glueing the lung to the diaphragm and ribs. The left lung was large and very sound, as were the heart and also the abdominal organs. We may remark, in the first place, that nothing could be so highly improper as to allow a man who had evinced unquestionable symptoms of mental derangement for some years, or, indeed, for any time, to keep loaded pistols at his side, day and night. In the second place, it appears that the "pectoriloquie" and the "retrecissement du coté" absorbed the whole attention of the physicians, and that nothing was done to remove the cerebral malady. In the third place, the pulmonic affection was not of such a nature as to threaten life for some years to come; and therefore had the mental disease been removed, there was a prospect of the patients's enjoying life and the society of his friends for an indefinite period. The case affords a memorable lesson to the medical practitioner, never to permit a patient (as far as he can prevent it) who has aberration of intellect, to be master of his own actions for a single day. 13. Compound Fractures. The general practitioners in the country are treading close on the heels of the exclusive surgeons in town. There is a far greater spread now than formerly of medical and surgical information among all ranks of the profession, and they are become bolder and more successful in their practice. The pages of our own Journal have contained ample proofs of this-and the Medico-Chirurgical Transactions owe no small proportion of their contents to this valuable class of medical society. Mr. Dunn is favourably known to the profession by a paper in a late volume of these transactions, containing a case of the removal of several of the tarsal and a part of the metatarsal bones followed by complete success. The present communication records two cases of compound fracture, in which the limbs have been saved by a similar removal of large portions from the middle of the cylindrical bones-and one of simple fracture, in which a projecting portion of Observations on Compound Fractures. By John Dunn, Esq. Surgeon, Scarborough. Med. Chir. Transactions, Vol. xii. bone was sawn off with equal success. present our readers with a succinct analysis. Of these cases we shall On the 17th of March, 1821, John Harper, a lad of 14 years of age, was thrown from his horse, and while one foot hung in the stirrup, the horse went off at full gallop. The consequence was. a dreadful fracture of the right leg-"the broken ends of bone projecting from a wound of immense extent, and a portion of the tibia detached, which he (Mr. Hagyard) removed." Mr. Travis and Mr. Dunn arrived by candle-light "And found the poor lad in a small and wretched hovel, extended on a couch, with a large wound, and destruction of the skin of the middle of the leg; the upper portion of the tibia projecting like a stick, unconnected with any of the soft parts, and deprived even of its periosteum, to the extent of between two and three inches, and the lower portion denuded of all covering to the length of three-fourths of an inch. The fibula was also fractured near the knee, and in the centre of the leg, so that it was divided into three pieces. It was, however, so connected with the surrounding parts, that the spicule of bone could only be discovered by the insertion of the finger into the wound. The teguments on the posterior part of the limb, although much bruised, were not deadened; and the circulation could be distinctly traced along the course of the posterior tibial artery. A considerable hæmorrhage took place at the moment of the accident, but it was now suppressed. The wound was six inches or more in length, and as many in breadth; but the boy was comparatively tranquil. On consultation, the grand question was, whether to amputate the whole member; to put it up in splints as it was; or to saw off the denuded rough extremities of the tibia, and treat it as an ordinary compound fracture. In this dilemma, which required immediate decision, we determined upon the last expedient. The tourniquet was therefore applied, the broken ends of the bone raised from the wound, and whilst the limb was held steady by one, and a bone knife kept under the exposed portion of the tibia by another of my friends, I successfully amputated the two extremities of the fracture, including about three inches of the whole cylinder of the tibia. We were unable to reach the fibula with any instrument, so that the two portions of the tibia could not be brought within an inch and a half or two inches of each other, without projecting the spicule of the former into the surrounding muscles." 169. Stitches were passed through the edges of the wound and their. sides drawn as near as convenient, when strips of adhesive plaster were applied round the limb, with an eighteen tailed bandage and splints. The patient went on favourably-the wound became so covered with granulations that the bones were no longer discoverable. On the 1st of May the report was "the sinuses diminished; the space between the bones filled up with solid matter; by compressing it on each side I could trace a continued line of bone." By the 26th of October the boy was walking about the streets. While we give Mr. Dunn every credit for his judgment and prompt resolution, in the above case, and while we most fully approve of the practice which he adopted, we venture to differ from him on certain physiological points-and this difference, we have stated in our review of Sir Astley Cooper's work on Dislocations; we need not, therefore, repeat it here.-See page 633. The second case related by Mr. Dunn, is that of a lad, sixteen years of age, who was stricken, on the middle of his leg, by a great plank of wood. Both the tibia and fibula were fractured. The ends of the former protruded from a very long wound, above half the length of his leg, having the appearance of a clean cut. The ends of the bones were very ragged-the most forcible extension could not place them in coaptation. It was, therefore, determined to saw off their extremities with the common amputating saw-No hæmorrhage of consequence followed-the wound was cleaned, and the bones put in apposition. About half an inch of the exterior part of the tibia was left denuded of its periosteum, but the rest of its circumference was connected with living parts. The leg was properly dressed, and the boy was judiciously treated. In four or five months the patient could walk without crutches. The third case was the removal of a projecting edge of the tibia, after a badly united former fracture. These cases are very creditable, as we before observed, to Mr. Dunn, and to provincial surgery in general. 14. Scrophula. Mr. Fosbroke, whose zeal and active spirit of observation bid fair to promote the advancement of his profession, has recorded a curious example of the extent to which a local disease, depending upon a scrophulous diathesis, may go. The patient was a young man, 20 years of age, who had been attacked for years previously, with an inflammatory swelling of the left knee, which extended down to the foot. The swelling of the knee suppurated, and, by all accounts, discharged a great quantity of pus. The thigh then became suddenly swoln-the hip-joint became obviously affected-large and deep abscesses formed at the posterior part of the thigh, at the superior spinous processes of the ilium, on the sacrum and lumbar vertebræ, about the shoulder joint, under the true ribs, in each lumbar region, &c. sometimes discharging thick pus, sometimes thin matter, in great quantities. The right extremity was gradually enlarging like the left. In the latter, large portions of the tibia and femur had exfoliated, and abscesses had formed where the process of ulceration had afforded a passage for the removal of cylindrical portions of bone. Some portions were necrotic, and passed away covered with a bloody sanies. The cellular membrane and cutis were thickened, "and effusions of the cuticle, in large brown crusts, covered the surface of these limbs, now of extraordinary * Mr. Fosbroke. Ed. Journal, No. 73. magnitude." "These scaly crusts, with the general dense enlargement of the integuments, gave some resemblance to the horny hide of a rhinoceros." All contour was destroyed, and the size and deformity of the left leg exceeded that which is seen in elephantiasis. At the time Mr. Fosbroke saw the patient, all acute symptoms had subsided, and notwithstanding the dreadful condition he was in, the animal functions contended with great vigour against the progress of diseased action. "It is singular," says Mr. Fosbroke, "that the most vital parts exposed had so completely escaped, viz. the muscles, arteries, lymphatics, and the sheath of the medulla spinalis." On this account, probably, there was less waste of life than in common psoas abscess. "My enquiries," says Mr. Fosbroke, "enable me to say, that scrophulous affections are more abundant on the southern coast than in more insular (we imagine this is a misprint for inland) situations. This fact, which is conformable to the opinions of Sir Astley Cooper, in his invaluable lectures, argues for the reverse of local representations." 15. Suicide, curious tendency to. A woman, 35 years of age, is now under the care of M. Falret for symptoms of phthisis. When 19 years old, the death of an uncle by his own hands, made a deep impression on her mind. She heard that insanity was hereditary, and the idea pursued her that she should one day fall into this wretched condition. She confessed her apprehensions only to the priest, who endeavoured to dissipate the mournful impression; and, in this state, she continued for two years, when the death of her reputed father, also, by suicide, riveted the conviction on her mind that her own doom was sealed. She was convinced that her blood was corrupted, and this idea appeared to her confirmed by her next menstrual secretion being less copious, and less coloured than usual. Tortured by this notion, she took the resolution of drowning herself. After leaving a letter in her chamber, apprising her friends of the manner of her meditated death, she plunged into the river, but being immediately drawn forth from the water, she was restored to life. The night following this attempt, she was harrassed with pain in the head; and, after a short sleep, she awoke incapable of recognizing any of the friends about her. She was evidently delirious, but made no allusion to her former melancholy apprehension. Although formerly religious and well-behaved, she now uttered nothing but obscenities. This delirious excitement continued three days, and was succeeded by melancholy and inclination to suicide. Headach again came on, with nausea and bilious vomitings, which, however, soon subsided. She emaciated considerably after this, and menstruation became irregular, being about once in three weeks, and scanty. M. Falret. Revue Medicale, December, 1821. She was the picture of despair, and could not look at herself in a glass without terror. Once more she invoked the aid of religion, which afforded her some consolation, but was insufficient to dissipate her sufferings entirely. Meanwhile, her mother revealed to her the secret, that her real father was yet alive, and after sometime passed in scepticism on this point, she consented to an interview with her father. The physical resemblance was so striking, that all doubt was instantly removed from her mind. From that moment, all idea of suicide vanished-her spirits and health became progressively re-established-and the menses only continued irregular for a few months. Fourteen years have now elapsed since the attempt at self-destruction. She is the mother of three children, and, during her married state, has been reduced to the greatest penury and distress. But she has never, since the period alluded to, entertained the remotest idea of suicide— on the contrary, she has proved an exemplary wife and affectionate parent, having the full possession of her intellectual faculties. The above case offers a good illustration of the power of moral emotions in producing physical lesions. The impression occasioned by her uncle's unhallowed death, evidently deranged her intellectual faculties. A melancholy, or chronic delirium preceded the attempt at suicide, and a maniacal, or acute delirium followed it. The effect of moral emotions was not less conspicuous in the cure, than in the production of the hallucination and tendency to suicide. One other reflection we shall indulge in here the impolicy of ever putting in rigid execution against the corpse, the inhuman laws against the crime. The only possible excuse for offering indignities to the lifeless clay, is the hope of deterring the living from following the example of the dead. But the revolting sensations occasioned by this cruel act, and the publicity and record of the act itself, are well calculated to produce, in the minds of relatives and even of strangers, that condition which leads to the catastrophe so much dreaded! Dr. Robert 16. Inflammation and Retroversion of the Uterus. son, of Glasgow, has detailed two or three interesting cases, in the Edinburgh Journal, where pain and intumescence, or inflammation of the uterus, in the unimpregnated female, appeared to produce a kind of retroversion of the organ, accompanied by a state of great suffering. The first case, however, is rather equivocal, and some people may still look upon it, as Dr. Robertson did, at first, himself, to be in some way connected with utero-gestation, though evident discharge of a blighted fœtus could not be perceived. The second case is less exceptionable, and we shall give some account of it. Dr. R. was called to a young girl, 19 years of age, and found her resting on her knees and elbows, weeping from pain. Ten weeks previously, she had been delivered of a still-born child, and had had * Dr. John Robertson. Ed. Journal, No. 73. Vol. III. No. 11. 4 R |