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sufering, and that the great benefactors ofmankind have been those who had capacityto study and to practise every branch of theprofession. Look at the pure physiciansand the pure surgeons of the present day ;what are they but the veritable Simon Pures !But to return : The information conveyed

in my last communication, I received from aFellow of the Royal College of Physicians ;and of its accuracy, I could furnish manyinstances, but that I am limited for time.To conclude : The insolence of the Licen-

tiate in giving the lie under the shelter ofan anonymous letter, and the personal re-mark with which he concluded it, and whichhe doubtlessly considers equally close andpithy, are in the very spirit of that mono-poly, by which, alone, such as he can ex-pect to raise themselves into the smallest de.gree of consequence or consideration.

DEMONSTRATIONS AT GUY’S

To the Editor of THE LANCET.

SIR,—Impressed with a full conviction ofthe many abuses in our Hospitals, whichyour highly valuable publication has alreadybeen the means of correcting ; and know-ing the great interest you have always takenin whatever affects the welfare of the stu-dents, and your readiness at all times to ad-vocate their cause, I have been induced to

trespass on your valuable time, and at therequest of several of my fellow pupils, tosolicit your kind interference with the greatwant, both of attendance and attention onthe part of our three DEMONSTRATORS in thedissecting room, which has been so severelyfelt by the class throughout the whole ofthe present session.Not to occupy your time unnecessarily, it

will suffice to inform you that as early aseight in the morning, the din of active pre-parations might be heard in the dissectingroom, and by nine, there is scarcely a tableunoccupied ; but no demonstrators are thereto assist us in our studies, and it is veryrarely indeed, until the late hour of twelve,that we have any advantage from their pre-sence. Our anatomical lecture begins at

two, on our return from which, they havevanished ; and hence, Sir, the short spaceof two hours, or two hours and a half, daily,at most, is all that is allowed, and doubtlessconsidered by them, sufficient to furnish thenecessary information to perhaps one hun-dred dissecting pupils ; and even, Sir, dur-ing that short period, I regret to add, a fewfavoured individuals monopolize their chiefattention, whilst the less fortuuate, not-

withstanding their repeated intreaties, aredestined to pursue their work of toil withthe assistance only of the London Dissec-tor, or some other typographical guide.,

Towards these gentlemen I entertain

feelings of the utmost respect, and I beg,Sir, to assure you, that it was not until afterthe most mature consideration, and withvery considerable reluctance, that I venturedto offer or trouble you with these remarks.

In the fullest hope, however, that theymay be productive of the desired effect,should you consider them worthy a place inyour esteemed publication,

I beg to subscribe myselfYour obliged Friend and Servant,

A PUPIL or GuY’s.

December 9, 1826.

HOSPITAL REPORTS.

HOSPITAL OF SURGERY,

Panton Square, St. James’s.

SECOND CASE OF CAROTID ANEURISM, SUCCESS’FULLY TREATED BY TYING THE ARTERY

BEYOND THE ANEURISMAL TUMOUR.

NEARLY a year ago, in our 122d Number,we recorded a case of carotid aneurism,which was succesfiilly treated by tying theartery beyond the tumour. Our readers mayrecollect, that such an operation was firstproposed by Desault, approved by Bichat,executed, with a fittal result, by Deschampsand Sir Astley Cooper, and treated withridicule and contempt by that truly greatanatomist, the late Mr. Allan Burns ; con-sequently, Mr. Wardrop undertook the ope-ration under the most discouraging circum-stances, as the only means of saving hispatient’s life, and he has been gratified bycomplete success, for we learn that the oldlady enjoys perfect health, and that not thesmallest vestige of the aneurismal tumourremains ; therefore Wardrop’s name will behanded down to posterity, if not as the ori-

ginator, yet as the probable rescuer from obLi-vion, and certainly as the first successful prac-ttser, of an excellent operation-an opera-tion which presents a cure for such aneu-risms as, from their situation, were deemedbeyond the reach of art, or which only ad-mitted of palliative treatment ; an opera-tion, the safety and utility of which havebeen demonstrated by two consecutivecases.

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Dec. 2. E. B., aetat. 57 : always enjoyedgood health till four years ago, when shewas attacked with severe pains in the head,which terminated in a fit of apoplexy. Bybleeding, the application of blisters, &c.,however, she soon recovered. Two yearsafterwards she had a similar attack, andwas ill for three weeks, but the same treat-ment being pursued she again was restoredto perfect health. About six months sinceone of her companions accidentally observeda strong pulsation in her neck, which a sur-geon discovered to be an aneurism of the

right carotid artery, and proposed an ope-ration, but the patient would not consent.A very strongly pulsating tumour is

visible on the right side of the neck, ex-actly under the sterno-cleido-mastoideusmuscle, which appears much attenuated, andits two portions are somewhat parted. Thepulsation extends from the clavicle abouttwo inches upwards, and is much strongerat the superior than the inferior part ofthe tumour, which does not, seemingly, ex-tend below the clavicle. It is fully two inchesand a half in breadth ; the external jugularvein is seen traversing the upper part of it,and is somewhat distended. The patienthas had a hernia in the right groin for fouryears, and both her legs are ocdematous,very tense, and painful. She complains ofsevere head-ache, and is unwilling to lie onher right side, because, when she does so,the pulsation of the tumour is increased,and is accompanied by much noise in thecorresponding ear ; sleeps little at night;appetite bad ; thirst great ; pulse natural infrequency, but with a slight thrill ; bowelsconfined.

], .Hydr. svbmur.Pulv. antirnon.Ext. rhei, aa. gr.ii. 1B1. ft. pil.,

to be taken at bed-time.

Dec. 3. Pulse fuller than yesterday;otherwise much the same ; to lose --vj. ofblood from the arm.

4. Symptoms much the same ; urinescanty, and high coloured :

R Pil. scille, 2îj ; ;Pil. hydrar&" gr. xiiPulv. digitalis, gr. iv; 1B1. ft. pil. xii.

one three times a day.6. Urine much more copious ; legs

much reduced in size, and less painfui;rests badly.R. Pi’ (pii. gr. ij. at night.7’. Slept well; is feverish to-day ; tongue

brown ; thirst urgent ; great sickness ; to

take 1 gr. opium.8. Sickness gone ; tongue still brown ;

bowels rather costive. To take some saltsand senna.

9. Slept well ; bowels regular ; felt verygiddy for some minutes this morning, andnearly fell from her seat.

10. Two grains of opium having beengiven in the morning, Mr. Wardrop, with theassistance of Mr. Lawrence, and in the pre-sence of many practitioners, tied the carotidartery at its emergence from beneath the omo-hyoideus muscle, and above the tumour. Asthe patient’s neck was fat, the incision madein the integuments was not less than threeinches in length ; the rest of the operationwas chiefly accomplished by means of asilver knife, and not above a tablespoonfulof blood was lost. The ligature, formed ofa portion of silk-worm gut, as recommendedby Mr. Fielding, was readily conveyedround the artery by Bremner’s needle, andafter being tied, both ends were cutaway.The external wound was secured by twostitches, and a strap of adhesive plaster.The patient felt no immediate effect from

the operation, except a slight faintness;she walked up stairs unsupported, and satsome time in a chair, before she would getinto bed.The effect on the pulse was very remark-

able, that of the right wrist being full andstrong, while that of the left was compara-tively small and feeble.

In the evening, the patient felt comforta-ble, complaining only of a dryness of thefauces, ,attributed to the opium she hadtaken. She was now ordered to have five

grains of calomel.11. Rested much better last night than she

has done for some time past ; no headache;she feels more lively than before the opera-tion ; countenance improved; pulsation inthe tumour much reduced, particularly inthe tracheal portion. Pulsation of the oppo-site carotid increased in force. The adhesive,

plaster was taken away; wound adheres;no appearance of inflammation.

12. Pulse of the right arm continuesmuch stronger than that of the left. Leftcarotid artery beats with increased force.

Temporal artery of the right side can befelt, feebly pulsating. No perceptiblechange in the tumour since yesterday;whole wound appears to have completelyadhered ; no dressing required ; no retuinof headache; health much improved; satup and dressed herself, and is in excellent

spirits. Tumour is easily diminished inbulk, by gentle pressure ; but on its appJi-cation, complained that the pain of’ thehead returned. She experienced two slightattacks of faintness yesterday afternoon,

* See Trans. ofMed. and Chir. Society ofEdinburgh.

397

with pain in the bowels. Bowels confined , ‘to take some salts and senna immediately.

-

13. This morning she feels perfectly easy,the medicine having operated well ; is quitefree from all those pains in the head whichtroubled her previously to the operation,and she can lie down in bed on the left sidewithout that feeling of suffocation whichwas formerly the consequence of it. The

pulsation is now confined to the externalpart of the tumour, and on pressing it thepains are reproduced (for the time) in the head, with the same violence as formerly.The two stitches were removed, perfect ad-hesion having taken place.,. Pil. Colocy)tth Co. 9j ; ;

Calomela,nos, gr. iii. M. ft. pil. v.one morning and evening.Thursday, Dec. 21. The patient is en-

tirely free from any uneasiness in the head ;has an excellent appetite, and states, thatin every respect she is " quit? comfort-able.As this patient in all probability will soon

leave the Hospital, those practitioners intown who are desirous of seeing her, hadbetter embrace an early opportunity.

ST. THOMAS’S HOSPITAL.

CASE OF STRANGULATED SCROTAL HERNIA,

In which the symptoms were somewhat ambig uous.

Gangrene of the Intestine. Operation, andfatal termination of the case.

WILLIAM PooLE, a chimney sweep, twentyyears of age, was brought to the Hospitalon Tuesday afternoon, Dec. 5, at five o’clockin the afternoon ; he was seen by the dres-ser, reported to have strangulated scrotalhernia of the right side, and was ordered tothe warm bath. Whilst in the bath, bloodwas taken from the arm to the amount oftwelve ounces, and the taxis was employedfor some time without success, when a mes-

senger was dispatched to request the at-tendance of Mr. Tyrrell, the surgeon of theweek.

It appeared from the patient’s stateme’nt, I(which, however, was by no means clear,)that he had laboured under hernia of the

right side for several years, but had neverworn a truss. The intestine, he said, oftencame down, but was in general easily re-

turned by his assuming the recumbent posi-tion and using gentle pressure ; on beingmore minutely questioned, however, hestated that there was always some degreeof swelling at the part. In the present in-stance the intestine descended on Saturday

evening (at first he mentioned Friday) ; hebegan to vomit on Sunday morning and hadcontinued to do so at intervals up to thetime of his admission.

Such was a brief history of the case, withrespect to the local symptoms, at the timethe patient was seen by Mr. Tyrrell ; afterremoval from the warm bath, they were asfollows :-On the right side of the scrotumwas a swelling of the size of a double fist;it was tense, tender to the touch, and gavean indistinct sense of fluctuation ; the in-teguments on its anterior surface were redand shining ; the cuticle, on close exami-nation, had a desquamatory appearance. Thetesticle could be distinguished at the backpart of the tumour, and felt hardened andenlarged; tracing the swelling upwardsalong the chord, it was found to extendthroughout the inguinal canal, and at thispart to the internal ring was hard and in-compressible. The swelling did not dilatein the least degree on coughing.The abdomen was not very tense, but

evinced some tenderness on pressure ; thebowels had not been relieved for three dayspreviously. There was occasional sickness,but no hiccup ; the pulse was small andquickened, but had not that peculiar threadyfeel, said to be characteristic of peritonealinflammation; the patient complained of asense of constriction at the upper part ofthe abdomen ; but there was no marked

anxiety of countenance, and when he wasdirected to bend his body forward, he did sowithout evincing pain.

Having ascertained the foregoing parti-culars, still Mr. Tyrrell considered the caseas dubious, and, therefore, previous to

adopting any plan of treatment, procuredthe attendance of Mr. Callaway. This gen-tleman concurred in opinion with Mr. Tyr-rell, that the case was ambiguous. Thecircumstances which he enumerated as con-stituting the ambiguity, were first, the pecu-liar shape of the tumour, it being unlike her-nial swelling, which is usually seen to enlargegradually from the external ring, whilst, inthe present case, the tumour enlarged, as itwere, abruptly. Next, the remarkable ap-pearance of the scrotal integuments coveringthe tumour, which was very similar to thechange that is produced in the skin whensuppuration is going on beneath. Lastly,the constitutional symptoms were supposednot to be those characteristic of an intes-tine having been strangulated for three days ;the absence of anxiety in the countenance,and of the vibrating pulse, were taken asevidences of the non-existence ofstrangu-

lation. In this state of doubt as to thetrue nature of the swelling, it was at length. determined upon, that a puncture should becarefully made at the lower part. This was