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well-regulated quarantine is capable of preventing the spreadof the disease.

C,

On the 14th October, 1857, a ship carrying coolie labourersfrom Madras arrived off Flat Island, the present quarantinestation of Mauritius, after a passage of twenty-six days, andreported thirty-three cases of cholera and eighteen deaths duringthe voyage; the last death having occurred five days before herarrival. The coolies were landed on the 16th. Shortly after,another coolie ship, from Calcutta, passed, and, reporting her-self healthy, went on to Mauritius; but as the ship’s registerof diseases had been destroyed, and as it was admitted by thecaptain and native doctor that cases of cholera had occurredduring the voyage, the ship was ordered back to Flat Island,and the coolies were landed on October 23rd. This island,about one mile in diameter, had been previously inhabited formany months by about 150 persons, consisting of Europeans,European and coolie workmen, the officers and servants of thequarantine establishment, with a number of prisoners engagedin forming a jetty at the leeward of the island, near to whichwere two wooden houses inhabited during the quarantine byfour workmen and five policemen. The whole of the personsan the island had been very healthy, only a few cases of ordi-nary diarrhoea and mild dysentery, and other trivial complaints,having to my knowledge occurred from the early part of Juneto October, and it having been reported to me, on good autho-rity, that scarcely a severe case of disease had been known onthe island for many months preceding my arrival. Both ship-loads of coolies were landed on the jetty, mustered close to thewooden houses before referred to, and their names called over,which necessarily detained them there for some time; theywere afterwards sent to the opposite side of the island, wherewere the huts for their accommodation, those of the Calcuttavessel being placed on Gabriol Island, separated by a coral reeffrom Flat Island.Two cases of simple bilious diarrhcea occurred soon after the

landing amongst the Madras coolies, who were in a muchbetter physical condition than those from Calcutta, but no caseof cholera until the 26th of October, nine days after the land-ing, when a Madras woman was seized, and died the next day.Two cases, one of simple and one of choleraic diarrhoea, werereported on the 27th amongst the Calcutta coolies; but no newcase of cholera until the 29th, when a workman living at thejetty, and a policeman who had been on duty at the same placeduring the landing of the coolies from both ships, but who hadafterwards been stationed on Gabriol Island with the Calcuttacoolies, were simultaneously attacked. On the 30th, a Madrascoolie was admitted with choleraic and a Calcutta coolie withsimple diarrhoea. On the 31st, one case of cholera and three ofcholeraic diarrhoea occurred amongst the Calcutta coolies. Nov.Ist, we had one case of cholera amongst the Madras and oneamongst the Calcutta coolies; Nov. 2nd, three cases of choleraand one of choleraic diarrhoea amongst the Calcutta coolies;Nov. 3rd, two cases of cholera and two of choleraic diarrhoea,also amongst the Calcutta people ; Nov. 4th, two cases of cho-lera, one from the Madras and the other from the Calcuttacoolies.On the 3rd November, seeing that cholera was largely on

the increase, it was determined to remove the coolies fromGabriol to Flat Island; the removal was commenced on thatday and completed on the 5th. From this date, no new caseof cholera occurred until the 19th, when a Calcutta coolie wasattacked; and on the 20th, another of the workmen livingnear the jetty : after which the disease entirely disappeared.It may be remarked that the disease seemed to be localizednear the jetty ; for in addition to the two cases of cholera oc-curring there amongst the workmen, several other policemenand workmen on duty at the spot suffered more or less fromdiarrhoea.

(To be concluded.)

THE POISONOUS TREES OF THE BOULEVARDS.—Muchexcitement is said to have been produced in Paris by theannouncement made in the name of several savans of renown,ef the dangerous nature of the trees now being planted on theBoulevards. The belief is current that this tree is of the mostpoisonous nature, " being no other than Tsichu of the Chinese,from which the varnish is gathered, a single drop of whichrunning from the tree causes the most venomous ulcers to arise i- ulcers which are incurable, and end in the painful death of Ithe victim." Of course this is a groundless canard; mean-while it is said to be amusing to witness the care with whichthe promenaders avoid either walking or sitting in the shadeof these " arbres maudets," as they are already called.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

ST. BARTHOLOMEW’S HOSPITAL.STRANGULATED OMENTAL HERNIA, IN A WOMAN AGED

SEVENTY-FIVE; OPENING OF THE SAC AND REMOVAL

OF OMENTUM; CONVALESCENCE.

(Under the care of Mr. STANLEY.)

Nulla est alia pro certo noseendi via, nisi quam plurimaset morhornm etdissectionum historias, tam aliornm proprias ,collectas habere et inter se com-parare.-MORGAGNI. De Sed.et Caus.Morb.lib.14. Procemium.

As we have remarked on previous occasions, the peculiaritiesexhibited in the various forms of hernia, are sometimes very re-markable. These, perhaps, are the more striking in the aged,for in them, owing to the long standing of the rupture, wecommonly meet with adhesions, and the appearances, even onexamination by experienced hands, are often deceptive as tothe actual nature of the tumour-whether, in fact, intestine oromentum has protruded, or both.On the 19th of November, a case of this kind was brought

into the operating-theatre, in the person of an old woman,aged seventy-five. The particulars of her history, so far aswe could gather, were, that she had symptoms of strangula-tion on the 15th, which became more urgent the next day.The taxis, applied by Mr. Goddard, a surgeon of St. John-street-road, failed to produce relief, and she was brought tothe hospital, and admitted into Lucas ward. She had beenthe subject of an umbilical hernia for many years, which hadbecome irreducible.When under the influence of chloroform, given by Dr.

Martin, the taxis was tried, and the tumour became a littlesmaller, softer, and not so tense, but its complete reductioncould not be accomplished.

It was now deemed advisable, by Mr. Lawrence, Mr. Skey,Mr. Paget, and others of the surgical staff present, to performthe operation for reduction, and be guided by circumstances asto ulterior proceedings. Accordingly, Mr. Stanley made hisincisions above the tumour in the umbilical region, but on ex-posing the upper part of the sac, moderate pressure failed toreduce the hernia.

It now became a question whether the tumour should be leftin the state in which it was, apparently consisting of intestineandomentum, orwhetherthe operation should be proceeded with.The appearances were so deceptive, that Mr. Lawrence couldscarcely distinguish between these two substances. Mr.Stanley extended his incisions over the sac, which was opened,and contained hard and thickened omentum, much congested,and strikingly resembling intestine, but none of the latter wasfound to be protruding. Folds of this were adherent to thewalls of the sac and margins of the ring, and two or three largeportions were removed, followed by a little bleeding, whichwas controlled by ligatures, and the lips of the wound werebrought together by sutures.Mr. Stanley observed there was a reasonable prospect of the

patient doing well, for she appeared to possess a certain amountof stamina and vigour which augured favourably. There wasno evidence to show that bowel had protruded in the presentinstance, although the tumour seemed smaller and softer whenthe taxis was employed; but the case altogether was a verystriking one, and of a nature such as probably the studentmight not witness once in a hundred instances.Of the value of the taxis under chloroform, we had an illus-

tration, on the 17th of November, at University College Hos-pital, where a young man, the subject of a congenital inguinalhernia, with symptoms of strangulation since the 13th, and whowas sent up from the country to be operated upon, was submittedto well-directed efforts by Mr. Erichsen in the operating theatre,when the hernia was completely reduced. The warm bathand the taxis, employed in the ward, had proved unavailing;he was then removed into the theatre for operation ; but a trial

I was given to the taxis under chloroform, which so completely

576

relaxed the muscles as to permit of reduction with comparativefacility.On the 27th of November, we found Mr. Stanley’s patient

progressing most favourably, ’without any bad symptoms sincethe operation. She has been allowed beef-tea, and severalounces of brandy daily. Her pulse is strong. She complainsonly of a little pain in the navel, and there is some offensive edischarge from the wound. A good recovery is confidentlyanticipated.

RESULTS IN A CASE OF EPILEPSY FROM FRACTURE OF THE

SKULL, AFTER THE USE OF THE TREPHINE.

(Under the care of Mr. LLOYD.)In the month of April last, we placed upon record (THE

LANCET, vol. i., p. 365) an instance of compound fracture ofthe skull, which gave rise to epileptic fits. These were treated,when recovery from the injury had taken place, by the use ofthe trephine, and we promised our readers an account of theprogress of this important case, and the influence the measuresadopted might have upon the recurrence of the fits.The patient, aged thirty, a mariner, from Sndbury, Suffolk,

of good constitution, was knocked down on the deck by a sailin November, 1856, and fell on an iron bolt, which was forcedthrough the cranium, near the coronal suture, on the rightside, making a hole the size of half-a-crown. Although insen-sible for twenty-four hours, he recovered, the wound nearlyhealed, and he returned to duty within fortnight. Somepieces of bone were subsequently removed. In June, 1857, thewound being quite healed, he had a fit, which lasted twentyminutes. Shortly after this a piece of bone was removed byDr. Jack at the Hong-Kong Hospital. In July another fitoccurred, and two small pieces of bone were removed. In

August the wound had healed; but a severe illness (fever) atFoo Chow-foo, of six weeks’ duration, was followed by fitsevery fourteen or twenty days.He was admitted into St. Bartholomew’s Hospital on the 8th

of March, 1858, in Pitcairn ward, and after being in threeweeks (during which he had two fits) it was agreed that thetrephine should be applied, and this was done by Mr. Lloyd,in the manner described on a previous occasion, on the 27thMarch. The following is a continuation of his case :-On Sunday, the day following the operation, he went on

quite well ; but on Monday and Tuesday fits recurred everyfour hours. Ice, &c., were applied. Fifty-four days now passedwithout any fits-the longest interval in which he had been freefrom them. They recurred on the 23rd May, 10th, 22nd, and29th June, and he left the hospital on the 3rd July. On the18th July he had a fit in church, and again had one on the19th August.When last seen, on the 31st August, by Mr. M’Whinnie, a

small wound was present, with no pain. A little red precipi-tate ointment was ordered. He could not perceive any pulsa-tion in the wound, nor detect by gentle exploration any bone,and he recommended non-interference. The patient had worn aseton for eight months, during which period, however, he hacno diminution of the fits. They have diminished in numbersince the operation, and the last fit, Mr. M’Whinnie informecus, seemed to have been brought on by over-exertion, aboulwhich the patient had been previously cautioned. He has returned to the country.

November 27th.-Mr. Lloyd mentioned to-day that he ha(very recently seen the patient, whose fits appeared at longeintervals, and were of short duration. An exfoliation of bon,was about to come away from the old wound, and the manfelt so well that he had gone to Liverpool to seek employmenas a seaman. Mr. Lloyd believes that a cure may ultimatel:be anticipated, especially after the exfoliation is thrown off.

LONDON HOSPITAL.

SETON IN UNUNITED FRACTURE.

(Under the care of Mr. CURLING.)

A HEALTHY man fractured his left humerus twelve months

ago in two situations, at the junction of the middle and lowerthirds, and of the middle and upper thirds. The latter, or

upper fracture, united by bone; but a false joint formed at theseat of the lower fracture. He was admitted a patient in theabove hospital, and had the false joint treated (on the 4th ofNovember) by the passage of a seton between the two ends ofthe broken bone. This was effected by Mr. Curling, who at

the same time found that the course of the fracture wasoblique, and prevented the passage of the long needle with theease that might have been anticipated. In some remarks whichwere made on this occasion, it was stated that non-union offracture was more commonlv met with in this situation than inany other part, and is especially liable to happen if the frac-ture is a double one, and also if the supply of blood is cutoff by destruction of the nutritious artery of the bone. No fairer example can be shown to the surgical student of thenecessity and importance of knowing the value and situationof the nutritious artery than a case of fracture of this kind;for the prognosis, to some extent, depends upon it. In sucha case as the foregoing, the broken bone is unfavourably situatedfor union.We recollect an almost precisely similar case to Mr. Cur.ling’s, in an elderly man, who was a patient of Mr. ThomasWakley, in the Royal Free Hospital, and was admitted underthe care of that gentleman with a false joint, the result of non-union of a fracture at the lower third of the left humerus. Theends of the broken bones were exposed and sawn off, and ossificunion ensued. A record of it was given in a former " Mirror."We have heard Mr. Stanley, at St. Bartholomew’s Hospital,give an explanation, in a clinical lecture, why false joints areso commonly met with in the arm as compared with otherparts of the body, and one that deserves some consideration.It is to the effect that when the fracture occurs just below theinsertion of the deltoid muscle, the action of that muscle is con-tinually moving the end of the bone about, and so prevents itsbecoming united. When the fracture fails to unite, Mr. Stanleyhas observed that success is very rare indeed in subsequentefforts to obtain union.The progress of Mr. Curling’s patient up to the present

time is so far satisfactory as to warrant the anticipation of agood result. Violent inflammation followed the introductionof the seton, which was removed at the end of a week, a greatdeal of swelling being present, with much discharge. These-were allowed to subside, and the wound to heal, which occurredin about six days, when the arm was carefully bandaged ingum and starch, and placed in an angular splint, and will beso retained with the utmost quiet for three or four months,until perfect union is obtained. The general health of the manis good. He does not now complain of pain, but experiences aslight shooting sensation at the seat of the old fracture.

CLINICAL RECORDS.

DISEASE OF THE TROCHANTER MAJOR, SIMULAT-ING MORBUS COXARIUS.

’ THERE is a class of diseases which occasionally simulatesclosely affections of the joints. These are various diseases ofthe parts in vicinity to the joints. The diagnosis is a matterof great importance, and often of some difficulty. This is wellillustrated in a case at the present time in the female operationward of St. Mary’s Hospital. The patient was admitted underthe care of Mr. Coulson, complaining of symptoms which resem--bled those of morbus coxarius. She limped painfully, and withthe greatest difficulty. The parts around the hip-joint wereswollen and tender; there were marked nocturnal exacerba-tions ; there was a sinus midway on the outer aspect of thethigh, and rotation did not increase the pain felt. Mr.Coulson decided that it was a case of necrosis of the trochanter,and laid open the sinus freely in its whole extent. At the-bottom was found a great portion of the trochanter, lyingloose. Subsequently another portion of bone exfoliated, andshe is now convalescent.

AMPUTATION OF THE THIGH BY RECTANGULARFLAPS.

A LAPGE, well-built man, a groom, had his leg amputated onthe llth November, at St. George’s Hospital, for disease of theknee-joint. He had been a patient in the hospital for somemonths, and the history of his case was to the effect, that four

years ago he was kicked by a horse on the head of the righttibia; chronic inflammation supervened, and destroyed the; surfaces of the bones; an abscess formed at the outer side of.

the leg, passing through the head of the tibia, and communi-. eating with the joint; the head of the bone was at the sametime much expanded. Mr. Pollock stated there was only thechoice between resection of the joint and amputation. In con-consultation with big collegues it was decided to have. recourse