finger of his left hand entangled in an iron chain employed in raising a very heavy weight; it was torn off at its second phalanx near its joint with the third. He applied at the hospital, and the house-surgeon found it necessary to amputate the ragged end of finger, which was done about the centre of the second phalanx. Nothing particular occurred until the sixth day after the accident, when he was attacked with rigors and pain in the hand. On the next day he was admitted into the hospital under Mr. Brodie.

tympanitic, the symptoms merging into symptomatic typhus; there was also slight oppression at the chest.

After this rigors took place at intervals-there was generally a disposition to perspiration-he had rambling delirium, yet if asked how he felt himself would say he was well-he passed his stools under him. On the 12th day a depôt was observed in the right thigh. On the 13th, diarrhoea having set in the oxymuriate was discontinued; it had obviously been productive of no benefit. A puncture was made in the hand first affected, and a good deal of

⚫nance.

Numerous leeches were applied to the fore-arm, and calomel purgatives with fomentations, and antiphlogistic measures resorted to. On the next day the swelling was greater, and the pyrexia continued. On the 8th day, more pain-much swelling of the palm and dorsum of the hand diffuse redness, tension, and tenderness of the latter. Leeches were again applied, and repeated on the following day. On the 10th day the hand was much the same, saving that the redness had in some degree subsided-pyrexia, with irritability, and some depression. This night he had a rigor followed by a slight hot stage, but much sweating. He looked - 'anxious, low, and ill. He complained now of stiffness in the right arm, on the outside of which was tenderness, fulness, and a slight circumscribed erythematous blush; in short, a purulent depôt was here forming in the cellular -membrane. There was a similar appearance commencing on the outside of the right fore-arm. Mr. Brodie determined to try the effects of the oxymuriate of mercury, which he ordered in doses of one-eighth of a grain three times daily.

On the 11th day he said he was much better, which patients labouring under the depôts most commonly do; his pinched and anxious countenance gave his tongue the lie. The belly was now

in the depôt in the thigh, and pus discharged. On the 16th day, the diarrhoea being checked, the oxymuriate was resumed. He now became rapidly lower, the breathing grew frequent and oppressed, and he sank early in the fol lowing morning. For the last two or three days there had been no rigors.

There was no affection of the thoracic or abdominal viscera. The cranium was not examined, neither were the limbs, in consequence of the great repugnance of the friends.

CASE 2.-Amputation of Finger --Erysipelas-Death.

William Green, at. 19, applied at the hospital as an out-patient, at the latter end of December, 1830, with disease in the joint between the 2d and 3d phalanges of the right fore-finger. The cartilages were ulcerated, there was great thickening of the soft parts, and several sinuses led down to the diseased joint. The disease had been the result of a slight accident. He went in the first instance to the Middlesex Hospital, but left it to apply to this.

Splints, &c. were employed, but the finger not becoming much better, and the lad being extremely desirous of its removal, it was amputated on January 15th, nearly midway between the metacarpo-phalangal and first phalangal joint. On the following morning the lad complained of feeling ill, and was rather feverish; he was therefore admitted into the house.

In the afternoon he had a rigor, and in the evening pyrexia; there was some

fulness about the stump. Ordered some calomel and James's powder, house physic, and salines. On the 17th the pulse was more frequent, with headache; there were pain and starting in the stump, and a little diffuse redness about the dorsum and palm of the hand. On the 19th he was extremely irritable, and vomited several times. Some diffuse inflammation of the skin and cellular membrane, and also of the absorbents, appeared on the back of the -hand. On the 20th the absorbents were inflamed as high as the axilla, where an enlarged and painful gland could be felt. The nitrate of silver was applied round the arm, above the inflamed absorbents and gland; the salines were continued. On the 21st there was little alteration. The nitrate of silver was applied over the inflamed surfaces on the hand and outside of the elbow. In the night he became quite delirious and unmanageable. On the 22nd, the face had a dull flush on itskin dry-pulse 130, feeble-tongue red at the tip, white on the dorsum bowels not open. He was extremely irritable and rather incoherent. Erysipelas of dull colour and without much -vesication had appeared round the parts to which the nitrate of silver had been applied, this having produced vesication. The streaks produced by infamed absorbents of the arm had nearly disappeared, but the axillary gland was still painful. The inflammation had never passed beyond the upper boundary of nitrate of silver. In the evening he had a furious paroxysm of maniacal delirium the erysipelatous redness of the hand and elbow had spread, with deep dull colour and indistinct margin. He obtained no sleep till 5 A. M. of the 23d. On that day he was very low, with pulse 140, dry tongue, sordes about the teeth. The urine was drawn off; there was scarcely any in the bladder. He lay in a stupid state, scarcely answering any question. He was ordered some bark and ammonia, and a saline injection was administered.

24th. Passed a pretty quiet night. The stupor has now all the characters of that produced by effusion on the brain. He takes little notice of what

is going on around him, but every now and then he suddenly utters some unconnected and irrelevant cries. Pupils dilated and sluggish-pulse 130, feeble

teeth incrusted with sordes-tongue dry, reddish brown-skin cool. The erysipelas has, for the last two days, been spreading on the fore-arm and hand, but little so upon the arm; it is of the same characters as before.

Emp. canth. nucha. Radatur caput et infr. capito raso ung. hyd. necnon etiam cruribus. P. c. h. cinchona.

On the 25th he was a shade better, calling on the house-surgeon by name, and appearing in all respects more sensible. Erysipelas had left the hand, and was spreading up the arm. Next day the gums appeared somewhat mercurialized. He continued a little better -pulse 110-no heat of skin. Camphor liniment was applied to the head instead of the mercurial ointment. On the 27th there was little alteration. The erysipelas had left the fore-arm and was creeping up over the shoulder, with little tumefaction, a tolerably good tint, and pretty distinct margin. The gums were decidedly affected-small pustules had appeared about the head. He was ordered a little porter. On the 28th there was little alteration. The blister on the neck, which had previously. been dressed with mercurial, was now treated with savin ointment. Ordered some infusion of cinchona and cusparia.

On the 30th, the erysipelas had left the arm, but was spreading a little on the back-he would not take his food or medicine so well as before.

Emp. canth. capiti raso. Hyd. sub. gr. ij. Ext. Lactucæ, gr. v. 8vis. horis. Adde haustui Amm. carb. gr. v.

FEB. 2. There has been little alteration in the symptoms since the last report, save that the patient has been gradually sinking. There has been no further return of intelligence, and he has scarcely spoken for the last two or three days; now and then, when disturbed, he will mutter a few unintelligible exclamations. The erysipelas has extended a little on the back, but it is trifling both in character and in extent. Emaciation has taken place to a re

markable degree. On the following morning he died.

SECTIO CADAVERIS. Cranium.-No traces of inflammation of the membranes or substance of the brain. No serous effusion between the membranes. Ventricles large, filled with clear watery fluid; there was about half an ounce in each.

Thorax. Old adhesions on both sides of the chest. In the upper lobe of the left lung some common tubercles, in stages of maturation and softening. Some had formed small vomicæ about the size of nuts. The other lobe of the left lung, and the whole of the right were free from tuberculous formations.

Abdomen. Partial congestions and vascular injection of the mucous membrane of the lower part of the ileum. Here and there, small ulcerations in the mucous membrane, apparently not follicular, as in fever; there was no attempt at reparation.

We should mention that the stump had healed early, and without trouble.

Another instance of death from amputation of a finger, occurred in the practice of Mr. Babington. We have not preserved any notes of the case, but the following is an abstract of the particulars.

The patient, an old woman, was admitted with much disease of the thumb of the left hand. It was considerably enlarged, the integuments discoloured, and several sinuses led down to denuded bone in the phalangal articulation. Mr Babington removed the thumb below this joint. In a day or two inflammation attacked the cellular membrane and skin of the hand, and spread in an erysipelatous form up the fore-arm and arm. The swelling was not very considerable, the tint of the skin was a dull red, the margin tolerably distinct. Vesications occurred, but the cutis rapidly became mottled from extravasation into its texture, and then gradually died, exposing lymph and serum in the subcutaneous cellular tissue. The affection was by no means of that rapidly destructive character which traumatic gangrene assumes; it was in fact a mixture of erysipelas and

diffuse cellular inflammation, occurring in a very debilitated and aged person.. At the end of seven or eight days she: died, her constitutional powers being evidently incapable of sustaining, or even originating the reparative process. A case of a similar kind, though the patient ultimately recovered, occurred to Mr. Brodie. A finger was removed for disease of the first phalangal articulation. Erysipelas succeeded and passed up the fore-arm to the arm, where it stopped. Some incisions were necessary in the hand, and convalescence was slowly established.

V. CASES OF LACERATION OF THE
URETHRA.

CASE 1. Fractured Pelvis-lacerated Urethra.

George Plummer, a carter, æt. 49, admitted June 18, 1830, under the care of Mr. Keate.

Whilst conducting his horses and cart at 9 A. M. this morning, he had occasion to jump off the shaft, and was severely crushed between the wheel and a post. He sank down and has since been incapable of using his lower extremities. The accident happened at no great distance from the hospital, and at 11 A. M. he was admitted.

There was evidently fracture of the pelvis in more than one place. A projecting edge of bone could be felt on the left ilium, about three inches behind its anterior superior spinous process. There was little ecchymosis about the pelvis, a good deal on the outside of the left thigh. Some blood had issued from the orifice of the urethra ; he had made water about two or three hours previous to the accident."

Laid on back with pillows under knees. At half-past one P. M. the catheter was introduced-an obstruction occurred about the membranous part, but. was surmounted. The urine was bloody, but the greater quantity of blood issued at first.

Patient laid on Earle's bedstead, with a broad belt round the hips.

Vesp. Troublesome cough-some heat of skin. Urine drawn off, dark. and bloody, without coagula.

A

H. salin. c. Tinct. hyos. Mxx. Sp. ath. nit. 3ss. Oxymel. scillæ, 3j. Vin. ipec. mxx. 6tis hor.

19th. Urine thick and muddy-looking-pain in the pelvis on coughing. Pulse frequent, rather wiry-aspect anxious-no motion from the bowels.

Next day there was more pyrexia, and he complained of feeling "pain all over him"-the cough was troublesome, and expectoration difficult-the bowels open. The urine was now pretty clear. Ġum catheter had been retained

in bladder.

Linctus in tussim. H. sal. c. Vin. ant. t. mxx. Tr. camph. c. 3ss. 6tis hor. Omr. alia.

On the 21st he was better, and on the 22d the catheter was removed. The urine continued clear, but was highcoloured. At 1, a.m. of the 23d he had a rigor, succeeded by heat, which soon passed away. Was this rigor occasioned by his making water without the catheter? He had passed urine at 9, p.m. the preceding evening. At 11, p.m. he had another rigor, without apparent cause. There were neither local nor general symptoms of any consequence.

No further report is necessary. Finding some little difficulty in making water, he introduced the gum catheter for himself occasionally. On the 20th July he was removed from Earle's bedstead, and, on the 10th August, began to walk about with crutches. At the end of the month he was discharged cured, and said that his bones felt stronger than before. We saw the man lately, and he continued well; he had very slight lameness.

the interval, he had either made no water at all, or very little. No fracture of the pelvis could be distinguishedthere were contusions and effusion of blood, chiefly above and about the right natis, with some over the left hip. He complained of pain on moving the pelvis, and said he could not make water.

The catheter could not be introduced, the instrument appearing to hitch insome laceration on the left side of the urethra, whence bleeding readily oc

curred.

Tinct opii, mxx. Fotus abdomini. Knees and feet bound together-doubleinclined plane.

On the following morning the housesurgeon passed the catheter, and drew off some bloody urine. At 1, p.m. it was again found impossible to introduce it. On the 27th, the catheter was reintroduced, with less difficulty. The urine was less bloody, but porter-coloured, and apparently mixed with much lithate of ammonia. The constitutional symptoms were those of febrile excitement, and a good deal of irritability. It has been mentioned that the boy was unable to make water by his own efforts. The treatment consisted in perfect repose, starvation, and occasional purgatives.

30th. Has continued much in the same state. Can rarely make water without the assistance of the catheter, and then it issues but sparingly, and on pressure above the pubes; it is mixed with the lithate of ammonia and some blood. No fever. Ordered beef-tea.

Next day he was placed on ordinary diet. On Nov. 2d, we find that he had made water without the assistance of the instrument for the preceding 24 hours. He was allowed to get up. On Nov. 6th there were no unpleasant symptoms, and he could make water well enough, without any appearance of blood in it. Dismissed.

In the two preceding cases, the exact amount and situation of the injury are, of course, problematical. It is not unlikely, from the nature of the injury, the bloody urine, and the difficulty experienced in both cases in the introduction of the catheter, that there was

some laceration of the urethra. At the same time, it is reasonable to imagine that the laceration was not very extensive, because the urine soon ceased to be bloody, and no symptoms of its effusion into the cellular membrane ensued. Perhaps, in such cases, the mucous membrane, or even the spongy part of the urethra, may be lacerated, without any injury of the external fibrous tunic. This is conjectural; the facts themselves are practically interesting.

CASE 3.-Ruptured Urethra-Puru lent Depôts.

We made the following memoranda of this case. It was treated last year

in the hospital.

A middle-aged, healthy, labouring man fell astride a chair, and struck his perinæum. He was admitted into the hospital soon afterwards. He had made water with great pain, and there was much ecchymosis about the perinæum and scrotum. An attempt was made, without success, to pass a large silver catheter; it seemed to pass between the bladder and the rectum, and blood only flowed. A smaller gum catheter was introduced on the first trial; it was left in the bladder. The catheter slipped out now and then, and some difficulties occurred.

In a few days the man had a rigor, then another, and another. An incision was made in the perinæum, and a large opening into the urethra was found, with a sloughy state of the cellular membrane. He seemed to be relieved, but soon became very low; he was ordered a little support. Rigors again came on; abscesses formed about the right groin and upper part of the thigh-then swelling and acute pain in the calf of the left leg. He died with the usual symptoms of the purulent depôts. He had complained, before these symptoms commenced, of pain in the side of the chest and in the epigastrium; it seemed to be sympathetic.

On dissection, a large sloughy depôt was found between the deep and superficial layer of muscles in the calf of the left leg; some smaller deposites were also found in the cellular membrane elsewhere. There was much destruc

tion of the lower wall of the urethra, opposite the incision in the perinæum, and also in another part, about an inch nearer to the bladder. The cellular membrane in the neighbourhood was dark and sloughy.

Several years ago, Mr. Brodie had a patient in the hospital with ruptured urethra. The accident occurred in a manner not very dissimilar to that in the last case. This patient died with the purulent depôts, but we do not exactly remember the particulars, and we do not possess any notes of the case. If our memory does not deceive us, there was a deposite of pus in the corpus spongiosum urethræ.

An instance of ruptured urethra, in a boy, occurred lately under Mr. Babington. It was necessary to make an incision in the perinæum, and the urine subsequently passed through the opening. When we saw the lad last, the perinæal wound was closing, and the discharge of urine by the natural channel was becoming daily more established.

VI. FRACTURED Pelvis.

In a former number of this Journal we reported two interesting cases of fractured pelvis, in one of which the bladder was ruptured, in the other the superior wall of the membranous part of the urethra, internal to the ligament of Camper. Both patients died with the symptoms and consequences of effusion of urine into the pelvic cellular membrane. The following case shews that fracture of the pelvis, unaccompanied with lesion of important organs or parts, is not necessarily fatal, even under unfavourable circumstances as to age and constitution.

Case. Mary Wilson, æt. 61, admitted Nov. 19th, 1830, under Mr. Hawkins.

She was received late in the evening of the 19th, having fallen from a ladder 12 feet high, immediately prior to her admission.

She was in a state of insensibilityarterial blood escaped from the right ear and from the nose-much ecchymosis over the os innominatum-right