84 Case of [leg's Amputation of both Feet.

being "~ell, as she stated that she had all kinds of medicine without it doing her any good. Upon examination I found the vagina quite healthy. No leucorrhea or other discharge. The os uteri was small and free from ulceration or other disease, but the cervix appeared congested. The uterus was normal as to size and position. Hanging from the os there was the characteristic discharge of transparent, tenacious, white-of-egg-like mucous. Upou intro- ducing the sound she complained of a good deal of pain. I treated the endo-cervicitis with the sulphate of zinc points recommended by Dr. Braxton Hicks, and with very good effect. I also ordered a blister to the sacrum~ and occasional tepid injections, but no constitutional treatment whatever was had recourse to.

The symptoms, however, gradually dissappeared as the local diseases yielded to treatment, and in four months from the time I saw her first she-was almost well. She has since menstruated regularly, and without pain ; but, I regret to say, it has been found almost impossible to break her off the habit of taking stimulants, which she acquired during her illness, as she was previously very temperate in her mode of living.

ART, III.--Case of ttey's Amputation of both Feet. By HENRY T~o~rsoN, M.D., Surgeon to the Tyrone Infirmary.

WILLIAM TAGGART, aged thirty-five, a railway guard, was admitted into the Tyrone Infirmary on the night of the 17th of September, 1871, having sustained a crush of both feet by a railway train passing over them at Newtownstewart--a town distant seven miles. As the train which did the mischief was coming in this direction, he was taken up and conveyed here by i t-- the feet having been bandaged up by the medicM officer of the district. I t was very late when he arrived, and he was much shaken and depressed, so I thought it better to subject him to no more torture that night, but, having ordered him some brandy and water, and a draught containing thirty drops of laudanum, to leave him for the night.

Sept. 18th.--He passed a very good night considering his condi- tion, and had quite recovered his strength, so I proceeded to examine into the state of the injured parts, and fbund all the meta*arsal bones of both feet, together with the phalanges of the toes, crushed and comminuted, their joints almost all open, and the

By DR. HENRY THOMPSON. 85

fragments of the-boRes driven into the soft parts in every direction. There was not a bone of either foot anterior to the tarso-metatarsal articulations that was not more or less injured, and the laceration of the soft parts extended above the insteps, so that there could not be an upper flai~ formed on either foot without several gashes through it; the soles of the feet were also much torn and bruised, and so penetrated by spiculm of bone, and dirtied and blackened with mud and gravel and cinders, that it was quite impossible to say how far the destructive effect of the contusing force had extended, except that, from the cold feel of the ends of the flaps on the plantar surface, I felt sure a considerable portion of them must Slough. Under these circumstances I had some difficulty in deciding what was best to be done, but at last determined on saving all the bones that were uninjured, and covering them as well as the state of the soft parts admitted. So I removed all the metatarsal bones of both feet by the operation described by Hey- - sawing through the projecting portion of each internal cuneiform. The flaps I made covered the bones well, but I had no expectation that they would escape sloughing. However, I gave them all the chance I could by keeping them well in position by means of as many sutures as were necessary, and putting them up dry and warm in llnt and cotton, which was continued until the 21st. The stumps were then enveloped in lint steeped in a warm solution of carboli~ acid, strength one in fifty, and covered with gutta-percha sheet. This thoroughly softened all the dressings, so that they were easily removed on the 23rd, when the edges of both flaps were found to have sloughed, and were separating by a very irregular line of demarcation; enough, however, being left of the thick integument of the sole to cover well all the parts of the stumps which were destined to support the weight of the body.

October 7th.--The sloughs had all cleaned off and the ligatures separated, so the dressing was changed for Turner's cerate, containing a 30th of carbolic acid, and he was allowed plenty of meat and porter.

I t is unnecessary to go through the detail of a tedious convales- cence, and sufficient to say that, after some months of varied treat- ment, the exposed parts became covered with skin, and he was able to bear his weight on the stumps, and at first, with the assistance of crutches, to move about.

B u t the interesting part of the case is, that after a little more time he became able to balance his body without even a stick, and

86 Case of Hey'8 Amputation of botl, Feet.

to waik and even run with but a very slight one. H e left the hospital before he could accomplish any of these feats, gradually acquiring more and more power, and did not return until the 22nd of dune, 1872, when he came to show me how well he had recovered. He had had a pair of boots made," lacing up the front, and with short feet stuffed with cotton, so that no one would remark or suspect his mutilation. His gait was of course more or less that of a man with club feet, but by no means remarkably so, and he is now quite able to fill some other situation under the railway board not requiring quite so much activity as his former employment.

This case is important as an instance of the value of conservative surgery. I fancy there can be but few, if there be any, eases on record of the loss of the metatarsal extremities of BOWH feet, and it must have been hitherto, in the absence of a ease in point, a matter of conjecture as to whether a man under such circumstances would re.tain the power of balancing. I t was my fear of the loss of this power that made me so anxious to preserve the attachment of the tiblalis anticus to the internal cuneiform bone, for I suspect that the stumps, after a double amputation on Chopart's plan, would be of but little use. I therefore thought it much better that he should incur the anticipated tedium of a prolonged cicatrization, than risk the loss of that important power.