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Post mortem, 36 hours after death.-After section of abdominal walls, about 1 gallon serous fluid, with shreds of lymph in it, was removed from the cavity. Small intestines coloured dark; bound together slightly by recent effusions of lymph, and contained small amount fluid fæces and air; stomach empty. Pyloric end of duodenum and upper part of jejunum very dark coloured, and coats thickened. The lower part of duodenum very friable. Colon and vermiform process not specially involved. Kidneys congested; right one much so. Congestion most marked between tubular and corticle portions. Bladder empty, muscular coat and lining membrane of the fundus-where covered by peritoneum--very much congested, a dark colour, and very friable. Lining membrane not much congested elsewhere. Liver congested and firm, also somewhat enlarged. Spleen congested.


Case of Fracture of the Ribs, with Wound of Lung. Reported by JoHN BELL, A.M.

On the 15th November, 1865, Thomas Frazer, a sailor, aged 57, of weather-beaten appearance, was admitted into the Montreal General Hospital, under care of Dr. McCallum.

In the early part of the preceding night, while intoxicated, he fell over one of the stone quays to the wooden wharf below. He says he alighted on his side on a pile of stones. He was immediately carried to his ship where he remained, insomnis, until removed to the Hospital.

Fracture of the ribs was at once diagnosed by Dr. Drake, House Surgeon, who ordered him to be placed in bed, as he suffered acutely from the slightest movement, on account of contused state of right shoulder and hip as well as from the more severe injury.

At the time of Dr. McCallum's visit, the extreme sensibility of the injured parts precluded a thorough examination, but it was nevertheless satisfactorily made out that the sixth and seventh ribs were broken about in a line with the origin of the serratus magnus muscle. The sixth somewhat anteriorly to the seventh, and both evidently fractured obliquely, from the ease with which they could be displaced, the amount of motion allowed, and from sensible snap with which they returned into place.

The subcutaneous cellular tissue for a considerable extent around the seat of the fractures was quite emphysematous, crepitating freely under pressure. After this had ceased to crackle under the bell of the stethos.

cope, two other sounds were heard; first, that friction of the opposed pleural surfaces, now in the incipient stage of inflammation, and secondly, a moist crackling, one from local pneumonia, caused by laceration of the lung tissue by the jagged ends of the ribs.

He is ordered calomel gr. j, antimonii tartarizati gr. † every third hour; to be cupped under right nipple, and to be put on milk diet. Tongue dry and furrowed; pulse 108 per minute.

16th. His feverish state, the pain which he constantly suffers, and the great embarrassment in the respiration, prevented him from sleeping more than a few minutes at a time during the night. From his inability to cough large quantities of mucus accumulate in his bronchial tubes, and produce a most painful sense of titillation. What he does expector ate is thick and tenacious, somewhat puriform and intermingled with a few specks of blood. The right side is dull on percussion. Sibilant râles abound behind on the right side, and with them a valvular click is heard at each respiration. A gurgling sound is occasionally heard over the position of the injury. All of these may be indicative of an inflamed state of some of the smaller and larger bronchi, with accumulation of


Friction sound more of a rubbing character than it was yesterday, but it changed somewhat during the day. Tongue moist and pretty clean, tip quite red. Urine sherry coloured.

The injured side of his chest was confined (after Hannay's method) with pieces of strong adhesive plaster, passing from the medium line behind to the same in front, and imbricated on each other until the whole was covered.

17th.-Slept pretty well last night, but not long at a time. Does not feel so feverish; tongue not dry, but still covered with a dirty coat. Skin moist. Bowels open. Urine abundant, slightly reddish, with a dimin■tion of chlorides, and containing a little urozanthin.

Pulse 80 per minute, full and forcible. Respirations 23 in the same time. Temperature in axilla, after allowing mercury full time to rise, 101.5 F. Observations taken each day at noon.

From the position and thickness of the plaster on his side, exact physical examination is prevented, but still the friction sound can be heard. It does not differ materially from that of yesterday. The patient now experiences no oppression or difficulty in breathing, the pain being altogether latent, so that he does not suffer except when he is compelled to cough or take a full inspiration. The irritation in his throat is less, and the expectoration is purulent in streaks, with a few specks of blood.

18th.-Patient slept somewhat soundly last night, and seems in every

way to be in a very favourable condition. All the secretions free. Face shews no febrile flush or fulness.

Pulse 72. Respirations 18. Temperature 100.4°.

A stripe of ecchymosis, of motled purpled yellow and green, three inches broad, has now appeared, extending from the fractures and in the same line with them, to the crest of the ilium. The impaction of the humerus between the wharf and his side was probably the cause of both these lesions.

19th. Patient was restless, and coughed a good deal last night, until the administration of a Dover's powder; after which he slept almost continuously until morning. He now looks very well and has neither coughed nor expectorated much. The Dover's powder is ordered to be continued each night, for a short time.

Above and around the seat of injury the respiratory murmurs are healthy. Below it, both behind and in front, the friction sound continues of a harsh rubbing character. A gurgling sound is also heard, which is quite distinct from that produced by the peristaltic action of the colon. Pulse 85. Respiration 21. Temperature 99.4°. Skin cool; tongue moist and pretty clean.

20th. Rested well during the night. The calomel and tartar emetic powders have been given as directed up to the present time. As the patient's bowels are now very lose and his gums "touched," they are ordered to be discontinued.

His appetite is poor. He is still on milk diet.

Friction sound well marked on occultation, and can be slightly felt on palpation. The gurgling already mentioned continues in the anterior and posterior part of chest.

He can now sit up and walk about. Pulse 80. Respiration 20. Temperature 100.6°.

21st.-Bowels still loose. Friction sound not so loud as yesterday. Respiratory murmur pretty clear and audible, contrasting forcibly with the superficial rubbing sound. The ecchymosis has now changed to an intense purplish black.

Pulse 76. Respiration 21. Temperature 100.7°.

His countenance to-day is relieved of the anxious expression it has hitherto constantly worn; and, generally, he seems to be in a decidedly convalescent condition.

22nd.-Pulse 76. Respiration 20. Temperature 101°. To-day he walks about with much ease. Percussion dull over fractures, where the friction sound is still harsh and grating. Occasional sibilant and submucous râles, with small gurgling, are heard at posterior part of


right side in some extent due, probably, to the hypostatic congestion of the back of the lung, and to accumulation of mucus in the bronchial tube, from the recumbent position which the patient has been compelled constantly to retain. Sputum not very abundant, but glassy and frothy.

23rd.-Pulse 68. Respiration 32. Temperature 100.4°. Friction sound still heard below the fractures, also a sonorous blowing sound from mucus in the larger bronchi. Bowels regular. Appetite improv ing. Has an annoying tickling sensation in his throat, for which he is ordered a sedative cough mixture.

Temperature 100.8°. On in

24th.-Pulse 65. Respiration 21. spection of the chest, the front part of the right side, which should have been supported by the fractured ribs, is seen to be flatter than the corresponding region of the left, and on percussion is duller.

25th.-Pulse 76. Respiration 22. Temperature 100.7°. Friction sound not so loud and harsh as yesterday, and heard chiefly at end of respiration. Cough greatly relieved. Patient can walk about freely, although some stiffness of the shoulder joint remains. He is ordered still to remain in bed.

As the temperature has maintained the same range for several days, its height being more probably due to incorrectness of the thermometer than to any abnormal state of the patient, its observation is ordered to be discontinued, as no longer necessary.


December 8th.-Patient to have his clothes, and to be allowed to get

12th.-To-day were removed the strips of plaster which have kept their hold in a most efficient manner. Whether from the good quality of the plaster, which was spread on thick twilled canvas, or from the very slight play of the ribs, the strips did not "become loosened after a few hours," contrary to the experience of Dr. F. Hamilton in such cases.

Friction sound still heard, over the side, and lower part of front and back of right chest, of a rubbing or creaking character: due most probably to the rubbing and stretching of adhesions which will remain permanently. That at end of inspiration coarser than that at end of expiration. It is only at these periods of respiration that the sound can be heard distinctly. The cough is almost entirely gone.

He can now throw his arm round in a circle, although it is slightly painful to do so. His side was ordered to be painted with tr. iod. co. 13th.-Friction sound continues much the but he same,

iodine application gave him considerable relief.



20th. The friction sound can now no longer be heard, and the right side of his chest has resumed its normal fulness. On examining the ribs

a swelling is felt on the fourth and fifth in the axilla, and also on the fifth at the nipple, evidently calli from complete or partial fractures, or All the patient now complains of is a slight

other lesions less severe.

stiffness about the right shoulder and chest.


Case of Injury of the land. by MR. THOS. D. LANG.

Under DR. D. C. MCCALLUM. Reported

John Bremner, aged 41, a native of Scotland, farmer has always enjoyed good health, up to the 13th December, 1865, when, while at work putting some straw into a thrashing machine, got his right hand involved in the cylinder, crushing and lacerating the first phalanx of the thumb, all the phalanges of the index and middle fingers, the first two phalanges of the ring finger, and the soft parts of the little finger.

He was admitted into the Montreal General Hospital, in this state on the same day that the accident occurred.

The man's occupation being that of a farmer, Dr. McCallum considered it prudent to save as much of each finger as possible; he accordingly removed the first phalanx of the thumb; all the phalanges of the index and middle finger, and the first and second phalanges of the ring finger. By careful dressing the little finger was saved.

The patient made a rapid recovery, and on the 6th Jan., 1866, was able to leave the hospital with a very useful hand.

The frequency of accidents, caused by thrashing machines, renders the above brief case of more than ordinary interest, showing, as it does, the results of Conservative Surgery. It was all important, from the nature of the man's occupation, to have as useful a hand as possiblewhich result was obtained by the attempt at saving his little tingerwhich proved successful, and confining the amputations simply to the injured phalanges.

Operation for Perineal Section. By DR. D. C. MCCALLUM. Reported by MR. JAMES HAYS.

Joseph Racicault, a native of Canada, aged 26, was admitted into the Montreal General Hospital, November 18th, 1865, under Dr. McCallum. Seven years ago he contracted a gonorrhoea and one small chancre, but had no bubo.

Three months before admission was employed on board a steam-boat,

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