the ear, with the edges of the skin overlapping the ulcer, I endeavoured to produce adhesion, but without effect; and as granulations had risen on the greatest part of the surface of the ulcer, the diseased skin appeared to be the chief preventive to its healing. I removed the skin, therefore, throughout the whole circumference, taking care that no portion was left behind, which was unconnected with the subjacent cellular membrane. A little dry lint was put upon the sore, and a pledget of the ung. lytharg. above it.

At the next dressing, the ulcer was evidently disposed to skin, and it healed rapidly, considering how serious a disease the constitution was already labouring under. I regret to add, that as the patient became reduced it reopened, he would not consent to the removal of his arm, and is, therefore, dead.

CASE V.

A young lady, about twelve years of age, had an ulcer behind the angle of the jaws; combined with considerable glandular enlargement, which had existed three years. Immediately below the ear, was another abscess, which had been burst some time, but the aperture was very small, and the skin not at all discoloured. A small pale and semi-transparent point of granulation protruded through this aperture, which I hoped, by adhering to its sides, would render other treatment unnecessary. But it continued in this state nearly three months, during which time the larger ulcer had healed, the gland connected with it much reduced in size, and another abscess under the sublingual gland, had been punctured, and united by adhesion.

It was particularly desirable, that this patient should be removed from under the eye of a too indulgent mother; who destroyed her daughter's health by excessive attention to it, and particularly by preventing her from taking exercise. I therefore advised her removal to the sea, but, previous to her departure, cut away the loose skin from off the abscess, and thereby reduced it to a simple ulcer, which would heal by any common dressing. I was not disappointed, for in six weeks she returned home, the ulcer had healed rapidly, her general health was established, and she has since continued well.

IX.

Notes of the Case of Thomas Watt, whose extensive Wound, and singular Recovery, were the subject of a Communication from Dr Halliday, in the last Number, p. 140. By JOHN GARRET, Hospital-Assistant to the Forces.

TH

HOMAS WATT, of the Royal Artillery, aged 18 years, was admitted into the General Military Hospital, Williamstadt, on the evening of the 7th February 1814, having received a severe wound on the left shoulder from a cannon-shot. The wound itself had the usual appearance of an extensive gun-shot wound, in which considerable loss of substance had taken place; a sloughy surface of the wound itself, and, surrounding it, the usual appearance of parts which have lost their vitality. It was evident that the greater part of the clavicle had been removed, only about an inch and a half remaining attached to the sternum. The humerus was severely fractured, just above the condyles, as was the last phalanx of the right thumb. The edges of the wound had been brought into contact as much as the nature of the case would allow, by sutures, and straps of adhesive plaster. The great contusion, however, of the surrounding parts, which had since become evident, prevented their being of further service, than in supporting the parts during the long and unavoidable journey to Williamstadt. He complained but of little pain in the wound. The fracture of the humerus, however, and of the right thumb, gave him, on the least motion, excessive pain. The wound was simply dressed this evening, and an opiate given him.

February 8th.-Had no sleep during the night, and this morning was attacked with a most acute pain in his left foot, which, on examination, was red, and painful to the touch. As he had been much exposed to very severe cold in his journey, this latter symptom was attributed to that cause. The foot was directed to be frequently fomented, and a purgative was given, and the opiate repeated at night; the wound much in the same

state.

February 9th.-Pain in the foot nearly subsided; a line of separation had formed between the dead parts and the living. Saline medicines were given, with the opiate, in the evening. February 10th, 11th, 12th.-The treatment was continued nearly the same, regulating the bowels, and continuing the

VOL. XI. NO. 42.

opiate in the evening. Had now become much more tranquil; the sloughs had nearly separated, and the granulations appeared florid and healthy. As the discharge had now become very considerable, he was directed to take the bitter infusion, with tincture of bark, three times a-day, and his opiate in the evening. The dressings were still of the most simple kind. In a few days, the sloughs had quite separated, and exposed a deep wound, extending longitudinally from the spine of the scapula to the axilla, and transversely from the insertion of the pectoralis major across the chest, to about one third the distance from the insertion of the muscle to its origin; the granulations and discharge were healthy, and his general health was good. It would be a tedious recapitulation of nearly the same symptoms and the same treatment, to give a daily narrative of this case. At the end of the month, the wound still retained nearly the same size; the granulating process, however, had gone on rapidly. The great discharge from the wound rendered it necessary to give him a liberal supply of wine, with animal food. Broad straps of adhesive plaster were applied from the arm across the chest; while lint, dipped in an astringent lotion, was applied to the new granulations. Under this treatment, by the middle of the fol lowing month, the wound had made great progress to cicatrization. Sinuses, however, had formed in various directions round the wound, the discharge from which was profuse, and pieces of bone were almost daily taken away. About this time, too, a troublesome cough, attended with pain in the chest, and expectoration, increased my apprehensions for the safety of my patient; and the more, as it was accompanied with profuse nocturnal perspirations, and a flushed countenance in the evening. The expectoration however did not appear to be purulent, and his appetite remained good.

The sulphuric acid was now combined with his medicine, the sinuses were injected with tincture of myrrh, and compresses of lint, which were retained in their place by broad straps of adhesive plaster across the chest, were applied in their direction. Under this plan, several of them healed up, and, by the middle of April, his general health was so good, as to enable him to sit up an hour or two during the day. The wound had become now about half of its original diameter; and though his cough was still troublesome, yet his strength improved daily, and his nocturnal perspirations had in a great measure subsided.

April 27th. This morning, on entering the ward, I found my patient in a more hopeless state than I had yet seen him. He complained of excessive weakness; his countenance was greatly dejected, and his pulse quick and feeble. On dressing

the wound, I found that part of the new cicatrix had ulcerated, forming an unhealthy circular ulcer, with livid edges, detached from the general ulcer. He was greatly exhausted with the fatigue of dressing. A stimulating aromatic mixture was directed for him, and he was desired to take freely of his wine. During the day, he was attacked with diarrhoea, which reduced him to such a pitch of weakness, that I despaired of seeing him alive the following morning. Two grains of opium were however given him at night, and a small quantity, combined with his mixture, given at intervals.

April 28th.-Diarrhoea a little abated; pulse still feeble, and is much debilitated. The ulcer has however assumed a more healthy appearance. Cont. med.

By the end of the week he had rallied wonderfully; the sore had nearly assumed its former state, and he was once more able to sit up during the day; his cough had become much less, and not attended with any alarming symptoms. The infus. quassiæ cum 'tinct. cinchon. 5ij, was directed for him three times a-day.

May 10.-He was able to be removed to another hospital, where I only saw him occasionally. He continued, however, mending slowly, under nearly the same treatment, pieces of bone being from time to time taken away from different parts of the shoulder. By the end of the month his health was so far improved, that he was considered able to be embarked on board the schuyts going with other patients to Antwerp, the estab. lishment at Williamstadt being ordered to be broken up. Since he has been here, very considerable portions of bone have been removed from the scapula, the remaining portion of the clavicle, and the humerus. His health has continued mending since he has been at this station, and is now so far recovered as to be considered quite out of danger. Except a few detached spots of unhealthy granulations, from whence bone is still occasionally taken, the ulcer is quite healed up. His cough has entirely left him, and he has recovered his colour and flesh, and walks out in the air. The fracture of the humerus above the condyles has united, and the last phalanx of the thumb was so shattered as to have come away in different portions. He has, as might be expected, little motion of the arm,-indeed none, except of the fore-arm, which only admits of passive motion, and he cannot yet dispense with the sling. Thus favourably has terminat ed a case in its commencement entirely hopeless, and in its progress attended with such a combination of unfavourable circumstances as frequently to put an end to all hopes of its ultimate recovery. It was rendered not less interesting from the extreme danger of the wound, than from the great tranquillity and forti

tude of mind with which this young man bore so long and severe an illness. Some idea may be formed of his situation, when it is considered, that, for two months, he was under the necessity of being raised up in bed to dress his wound, an exertion rendered particularly painful from the fracture above the condyles on the left arm, and the fractured right thumb. It is impossible, from the nature of the case, to indulge any sanguine expectations that the arm will ever be very serviceable. The wonderful manner, however, in which the loss of parts of the human machine is frequently supplied, and the age of the patient, may perhaps allow of indulging a hope, that in time he may have a freer motion of his arm than at present.