next day, he was bled to xvi. ozs. and had twelve leeches to the belly with relief. The bleeding was repeated on the 10th, and saline mixture ordered, but on the 12th there was a recurrence of pain in the belly with increase of pyrexia, for which he was cupped on the loins to 12 ozs. From this time he no longer required the catheter. On the 21st he had a rigor, the wound looked pale, and the discharge which had previously been healthy was scanty and thin, he had malaise and tightness about the head, the countenance was flushed, and the pulse 112. Bled from temporal artery -blister to nape of neck-castor oil— cul. gr. ij. ter die. He was immediately relieved by the bleeding, and on the 22d had no pain of head. Calomel continued blistered surface dressed with resin ointment. On the 26th, the mouth was sore, and the calomel discontinued; he felt well, and the discharge was good. On the forenoon of the 27th he had another rigor, and the wound above the temple had a glazed appearance with copious discharge of brown serous fluid. On introducing the probe it passed nearly four inches backwards to an elastic fluctuating swelling; this was immediately laid open to the extent of two inches and a half, exposing a considerable surface of the bone bare and rough. Eight ounces of blood were lost with relief to the pain in the head; pulse 116, sharp-countenance flushed-tongue clean-mouth nearly free from mercurial fetor. Dose of physic-blister to the head. On the 23th he was bled to ten ounces, and the calomel recommenced every three hours. On the 30th the pain of the head was gone, the pulse was 84, calm, the wound clean, the mouth slightly touched. Ptyalism took place, the mercury was omitted on the 3d October, the wound granulated and healed, on the 26th the patient was dismissed, and he has remained quite well to the present time.

The issue of this case is extremely favourable in comparison with what frequently follows the development of the symptoms it presented. Rigors on the 14th and subsequent days, are but too often the overture to the fatal drama of pus on the meninges of the brain, or purulent depôts in the liver or cellular

membrane. Calomel was used in this, as the preceding case, with a boldness not commonly evinced in the treatment of these cases. It will require further experience to determine its merits or demerits. Dr. Auchincloss' clinical remarks are brief and to the purpose.

"The preceding is an instance of concussion both of the spine and brain. Although the fall seemed to have been very severe, yet he suffered but momentary stupor, followed by vomiting. Symptoms of cerebral disturbance did not evince themselves till 14 days subsequent to the accident.

"These, as also the unfavourable symptoms which took place on the 27th, when he had a relapse, were ushered in, as is usually the case after injuries of the head, by a rigor, with a glazed, unhealthy appearance of the wound. When admitted he was free from fever, the local symptoms being pain at the lower part of the back, and in the hypogastrium. There was also retention of urine, with paralysis of the sphincter ani. These subsided after free depletion, both general and local, fomentations, purgatives, and the use of the catheter. Palsy of the bladder is a common effect of injuries of the back, but, in this instance, it seemed to be accompanied by actual inflammation of that organ, or of parts in the immediate vicinity. The treatment at first had recourse to was, doubtless, beneficial in lessening the tendency to inflammation of the brain, having lost during that period upwards of forty ounces of blood, so that he was very much reduced by the time the bad symptoms appeared.

"The utility of mercury after bloodletting was well marked in this case. The unpleasant symptoms disappeared, almost immediately, on the mouth becoming decidedly under the influence of that medicine. At both relapses, venesection was not sufficient to remove the pain, &c. Mercury, therefore, may be considered as one of the best auxiliaries to bleeding in the treatment of such cases. To ensure its full effect, however, I am persuaded that the medicine ought to be carried to the extent of producing smart ptyalism, as is so beautifully exemplified in the cure of iritis, and of some of the other disorga

nizing inflammations of the eyeball. In addition to its other effects of exciting absorption, &c. it may not improperly be said to act beneficially, partly, as a counter-irritant.

"The opinion was long entertained that a bone, when deprived of its periosteal covering, must necessarily exfoliate. The contrary, as I have often witnessed on other occasions, was seen to take place. The surface of the bone granulated, and in process of cure these granulations readily inosculated with those from the surrounding soft parts."

CASE 4. Slight Concussion—Simple Fracture of the Cranium-Severe pain in the Head. 66 George M'Donald, aged 40, was admitted 27th Feb. under the care of my predecessor, Dr. Couper. On the 2d Jan. preceding, when intoxicated, he had fallen down a stair, and pitched on his head. He remained insensible for 10 minutes after the accident. With the exception of a slight abrasion of the left cheek, there was elsewhere no mark of injury to be seen. He continued at his employment during the first week. He had then a rigor, was sick and drowsy, and affected with severe shooting pain in the forehead and across the temples. At length a small puffy tumour appeared over the upper part of the left parietal bone. This, having extended, was opened a few days previous to admission, and a quantity of matter discharged. In this situation, the bone was found broken into several small pieces, and slightly depressed. The integuments were undermined, and the probe grated on rough bone to the extent of two inches around the opening. There was no paralysis, and he seemed perfectly intelligent. Pulse 80. Bowels slow. He was bled from the arm, had leeches applied to the head, and was purged with decided relief. The headach again became severe on the 4th March, when leeches were repeated. He remained in the hospital till the 21st April, during which period he was never free of head-ach. The treatment had recourse to was the application of leeches and cold lotions to the head, the occasional use of purgatives, and an alterative course of mercury. On his leaving the hospital, the

following report is entered in the Journal: Has little pain in the head, and otherwise appears in good health No portion of the denuded and depressed bone has yet come away.'

"This person was re-admitted on the 16th May. The head-ach, which had been more or less constant from the time he left the hospital, was now particularly severe. There was no other bad symptom. He was addicted to dissipated habits, and had been living rather irregularly. The sore on the upper part of the skull was about the size of a sixpence. The surrounding scalp was quite adherent. The depressed bone felt rough, and was covered with flabby granulations. The treatment consisted in the application of blisters and the use of mercury to ptyalism. He left the hospital on the 11th June, still affected with headach, though much less severe. No change had taken place on the sore.

"He was again admitted on the 4th July, and in the interval had been living very abstemiously. The pain was constant and so severe, that he could neither walk nor stoop. He complained of loss of memory. A caustic issue was inserted in the nape of the neck ;-and the edges of the sore on the head, which were inverted, were pared. Two days subsequent to this, erysipelas of the scalp and face took place, preceded by a rigor. Delirium ensued early, and he remained very ill for nearly a week. The affection having subsided, healthy granulations sprung up from the surface of the sore, which speedily cicatrised, no exfoliation of bone taking place. He left the hospital perfectly free of headach on the 9th of August. I have not heard of him since the middle of Sept. at which date he was well and able to follow his usual employment—a tanner."

Dr. Auchincloss makes no remark on this case, but if the pain should return and continue severe, it will probably be necessary to trephine the depressed and diseased bone. Such was the successful proceeding adopted in some of the cases detailed by Sir Everard Home. By the way we believe that Mr. Brodie is preparing a memoir on the secondary consequences of injuries of the head.

The next and last case that we can notice, is brought forward to shew that the "puffy tumour" of Mr. Pott does not necessarily accompany the formation of matter on the dura mater. The case is short and incapable of abbreviation.

"A gentleman, aged 21, in descending a stair, fell forwards and pitched his head against the wall at the bottom of the stair. He was slightly stunned by the blow, and after a few minutes, rose up and walked home. There was no visible mark of injury on the head. He continued in his usual state of health for nearly a month. At length he became affected with head-ache, vertigo, and other cephalic symptoms. The pulse was about 40. Stupor and convulsions ensued, and he died apoplectic seven weeks from the receipt of the accident.

"Inspection. On reflecting the scalp and pericranium, which was everywhere firmly adherent to the skull, two fissured fractures were discovered on the upper part of the left parietal bone. These were situated an inch apart, and ran parallel to each other in an oblique direction, towards the sagittal suture, where they terminated. The dura mater underneath was separated from the bone, which was rough to the extent of three square inches. This space was occupied by dark coloured sanies, with a sloughy state of the outer layer of the dura mater. The inner surface of this membrane was of its natural smoothness and colour. The brain, particularly the cerebellum, was unusually soft."

We shall notice the other topics embraced in this report at another opportunity. Dr. Auchincloss is a well-informed, judicious, and apparently accurate surgeon. These are no mean recommendations in the present days of ostentatious pretension, and unblushing contempt of truth in medical periodical literature.

XXXII.

ROYAL WESTMINSTER OPHTHAL

MIC HOSPITAL.

THE cases of cataract which have occurred since our last report have been numerous, and many of them highly in

teresting. We will notice some of the most remarkable both for their character and circumstances.

CASE OF FLUID CATARACT. The first case is the most remarkable, being that of a perfectly fluid cataract of the left eye, contained in a thickened capsule, which Mr. Guthrie said was exceedingly rare, and that he had never seen one so well marked as in this instance. The patient, John Jones, was 56 years of age, a gardener by trade. The cataract had existed two years-the iris was perfectly tremulous, and the pupil moderately dilated under the influence of the belladonna. On bending the head forward, the opaque body was seen to advance through the pupil, bulging towards the under part in consequence of its gravity, and was in some degree pendulous also, evidently indicating its fluid contents.

Mr. G. observed, that if the operation for extraction were performed, he had no doubt but the capsule would come out entire, and the greater part of the vitreous humour followed. The operation was performed in the presence of Mr. Thomas and a number of students, on the 23d of March, in the following manner.

The eyelids being separated, and the eye fixed with the fore-finger and thumb of the left hand, a two-edged cutting needle was introduced about two lines and a half behind the cornea, and placed in front of the capsule, which was immediately cut into, when a small quantity of white turbid fluid escaped into the anterior chamber; by this incision the capsule was evidently separated from its attachments, and beginning to descend;-no further attempts were made therefore to detach it, lest it should float in the vitreous humour. The needle was withdrawn, and the belladonna applied in order to keep the pupil as much dilated as possible.

10, p. m. He complained of pain in the head, but not in the eyes, and has vomited. Eight ounces of blood have been taken from the temple by cupping, which has relieved him. Pulv. jalapæ c. 3j. st. sumendus.

24th. Pain returned about 4 o'clock this morning. Twelve ounces of blood

were taken from the arm, which was repeated at 11 o'clock, and again tonight, producing syncope. 25th. He has passed a good night, and had no return of pain.

26th. Apparently well-wears a shade. 30th. Discharged. Cataract is entirely gone, and he is able to see nearly as well as with the other eye. The only appearance of disease remaining is the tremulous state of the iris.

CASE OF SOFT CATARACT. James Herring, æt. 25, applied to have an operation performed on his right eye, as the white spot in it prevented his getting a place in the police. The cataract was large, soft, and white, pressing against the pupil, which was a little dilated, and, in consequence of the pressure, shewing the black edge of the uvea. The iris had slightly altered in colour, and the patient could distinguish but very little light.

Mr. G. observed this was one of those cases in which the inflammation following the operation would, without doubt, be considerable, and require the most active treatment; and although the eye would recover its natural appearance, he hardly expected the man would obtain good sight.

Feb. 25th. A two-edged cutting needle was introduced behind the iris and carried forwards between it and the lens, with its flat side lying upon the capsule. The superior cutting edge being now turned towards the capsule, both it and the lens were completely divided, and this was frequently repeated until the lens was evidently divided into several small pieces. The needle was then withdrawn, and the belladonna applied.

5, p. m. Complained of pain in the eye and side of the head, upon which 24 ounces of blood were immediately taken from the arm, and afforded complete relief.

B. Pulv. jalapæ, c. 3j. st.

B. Cal. gr. v.-Ext. colocynth, gr. v. post horas duas.

10, p. m. He has been cupped to 12 ounces, pain having returned.

26th. A return of pain took place at 2 o'clock, shooting across the forehead, when six ounces of blood were taken from the jugular vein, on which the

patient fainted. He slept for several hours after this, and was quite free from pain in the afternoon. Bowels thoroughly open-belladonna plaister has been applied over the eye and forehead.

P.M. Pain having returned in the eye, he has been again bled to 10 ounces, and is quite relieved.

27th. Slept tolerably well during the night, and is free from pain.

Vespere. He has again complained of pain in his head and back, and has been ordered 3j. of the vinum colchici. March 1st. The pupil is well dilated very little redness of the eye and no pain.

7th. He has complained to-day of a slight return of pain in the eye-cupped to viij. The broken portions of the cataract evidently diminishing in size.

23d. The absorption of the cataract going on but slowly Mr. Guthrie thought it right to repeat the operation, but it was now evident that a great change had taken place in the portions of the lens, their consistence being now much greater. In this operation the whole of the portions were brought into the anterior chamber. The belladonna was repeated as before. 6 p. m. He has complained of pain in the head and eye for which he was bled to 3xij. with immediate relief.

Eleven o'clock. Pain has returned and the abstraction of viij. of blood has afforded him immediate relief.

24th. Passed a good night and free from pain.

Nine p. m. A return of pain relieved by the abstraction of 3xiv. of blood.

25th. Quite free from pain, and going on very well. The portions of the lens are removing rapidly.

28th. A slight return of pain has taken place. C. c. temp. ad viij.

From this time to the 20th of April no treatment was required beyond the belladonna. When he was discharged the pupil was perfectly clear and round; he saw much better than had been expected and immediately obtained his place as a police constable.

CASES OF CONGENITAL CATARACT.

Elizabeth Buchanan, æt. six months, admitted having cataract in both eyes from birth. The pupils being dilated

with belladonna, and the eye fixed with a speculum, a needle was introduced through the sclerotic coat and the capsule divided which contained a small portion of soft lens-both were broken up as much as possible and pushed into the anterior chamber. The other eye was treated in the same manner. No inflammation ensued; great care was however taken to keep the pupils thoroughly dilated by the belladonna. Six weeks after this operation, that is in the beginning of November, the needle was again introduced in both eyes for the removal of a small portion of capsule. The belladonna was reapplied as before. No inflammation ensued, and the child was discharged cured-without a vestige of disease and apparently seeing very well.

Frederick Saene, æt. four, admitted November 10th, 1829. Cataract in both eyes. This child is also dumb and nearly deaf. November 11th. Mr. Guthrie broke up the cataracts of both eyes in a similar manner with the last case.

Nov. 21. The child has not suffered from the slightest degree of inflammation. The pupils are quite clear, and the child can see to run about, avoiding every thing in its way.

ANOMALOUS CATARACT.

Ann Brunun, æt. 28, admitted having an anomalous cataract in the left eye. The opacity occupies only the inner half of the lens and capsule when the pupil is dilated and presents a very defined margin somewhat of a circular form. There are a few opaque spots on the other parts of the capsule, but the difference between the inner and outer half of it is very remarkable. She says that she suffered an attack of inflammation in this eye when she was two years old, and which she believes has caused this complaint, and wishes to have it removed on account of the deformity it occasions.

Dec. 2d. Mr. G. passed a two edged needle through the sclerotic coat, and into the capsule, on the division of which a substance something resembling white powder started forth, rendering the aqueous tumour very turbid, not however sufficiently so to prevent a complete division of the capsule, which cut like a piece of parchment. Bella

donna ordered to be applied night and morning.

Dec. 13. She has suffered little pain since the operation, and it has not been necessary to abstract blood. One small piece of capsule alone remains in sight, which she does not consider any detriment, and says she can see a little with it, which she could not do before.

CAPSULAR CATARACT AFTER INJURY.

Eliza Uyan, æt. six. Has a capsular cataract in the right eye, apparently from an injury-there being a small cicatrix at the upper margin of the cornea as if something had penetrated that membrane. The capsule was broken up on the 2d of March, and on the 13th she was discharged, the pupil being quite clear, and the sight tolerably good-no inflammation supervened, and the treatment was confined to purgatives and the application of the belladonna.

CASE OF HARD CATARACT,

Edward Thompson, æt. 40, was admitted April 24th, having lost the left eye, which was sunk in the head after an operation performed in the country two years ago-the right eye appeared perfectly sound, with the exception of a hard cataract.

Mr. Guthrie standing behind the patient fixed the eye-lids and the eye-ball with the fore and second finger of the left hand. He then carried the extracting knife across the cornea, completing the punctuation but not allowing it to cut its way completely out. The patient having slightly recovered from this, the guarded knife was passed through the opening, and its cutting edge being pushed forward divided the remaining portion of the cornea upwards. The capsule being now torn with the hook, the lens gradually advanced and was removed. The cut edges of the cornea were duly adjusted and the patient put to bed.

April 27th. There appears a slight threatening of inflammation, but the patient experiences no pain. C. c. ad viij. temp.

From this time to May 16th he has not had an unfavourable symptom, and he is now ready to be dischargedthe pupil being perfectly clear and his sight restored.