S E C T. II.

Medical Obfervations.

İ.

Obfervations on the extirpation of a Cancerous Ulcer in the lower Lip. By Mr William Deas, Surgeon to the united Hofpitals of St Nicholas and St Catherine, Dublin, communicated to Dr Duncan.

N all our treatifes on the operations of surge

IN

ry, we are directed, after the removal of cancerous ulcers or excrefcences in the lips, to retain the divided parts in contact by means of the twisted future. This method I have always experienced to be attended with so many pain ful inconveniencies, that I determined to try if a fingle point of the interrupted future, fupported

by flips of sticking plafter and the uniting ban dage, might not be fubftituted with fuperior advantages; and, from many repeated inftances, I am now convinced it may. Of these the following is one.

September 2. 1777. A thin healthy looking old woman, aged fixty, came from the country to be received into the united hofpitals. She had a cancerous ulcer, which occupied near three parts of the lower lip, furrounded with confiderable hardness. It rofe, in feven months, from a fmall pimple, which appeared near the left angle of the lip, to its prefent condition. The fubmaxillary glands being perfectly disengaged, and there appearing no circumftance in her cafe to forbid the operation, it was performed without any particular occurrence, only taking care to make the lower angle, A, as acute B as poffible. The divided parts being brought together, a fimple ftitch was put at B, and another at C. Thofe were fupported with flips of sticking plafter, large compreffes on the cheeks, and a pretty broad uniting bandage, all fo placed as to counteract the retraction of the muscles. The ufual regimen in fuch cafes, and abfolute filence, were en

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joined.

joined. The third day the bandage and compreffes were renewed, and the fourth the wound was infpected. Above, the parts were perfectly united; but lower down there was a flight fuppuration, particularly on the points of the future. A small pledgit of dry lint, with the uniting flips of plafter and bandage, conftituted the whole dreffing. Her bowels were kept free by a gentle laxatives, and after the fourth day she took occafionally a decoction of bark. Fourteen days from the operation, the parts were firmly united, and nothing appeared but a fimple line of cicatrization; and, although her mouth was but fmall, it looked by no means disagreeable, or attended with any inconvenience. After having an iffue opened in her arm, fhe was difcharged the hofpital perfectly well.

If we contraft this mode of treatment with that where the divided parts are, as it were, fufpended on three needles, with waxed threads twisted round them, which pinch and contufe the parts engaged, conftantly irritating the muscles to retractions, and rendering the application of dreffings, bandages, &c. extremely painful; and all this in patients whofe vitiated habit of body fhould deter our giving the least unneceffary ir

ritation, I make no doubt there are few fur geons will hefitate an inftant, either in this cafe, or in that of the hare-lip, which to adopt; the one being eafy, fafe, and expeditious, in comparifon to the other, which is painfully complex and tedious.

But, in all cancerous cafes, previous to the undertaking any operation, I am of opinion the extract or juice of hemlock, notwithstanding its prefent low repute, should be first tried. And I have seen fome inftances where, in real cancerous cafes, it fucceeded, contrary to all expectation.

The Hiftory of a Cafe of obftinate Obftipatio, de pending on a stricture of the Rectum, communicated to Dr Duncan, by Mr Edward Johnftone, Student of Medicine at Edinburgh.

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AY 3. 1777. My father, Dr Johnftone of Kidderminster, was called to vifit Mrs Wright, a large made corpulent woman, about forty years old, and who believed

herself in the fifth or fixth month of her preg

nancy.

hancy. She was generally difpofed to coftivenefs, and most of all when pregnant.

On the 23d of April preceding fhe took an ounce of Glauber's falts to remove a fwelling with inflam mation in the lower part of her thigh. She was both vomited and purged by this medicine. The fwelling went off, but from this time fhe had no evacuation by stool; and every effort of art to procure the evacuation, however powerfully directed by my father, and my brother, Dr Johnstone of Worcester, proved abortive.

She took, for the space of four weeks, purgatives of every clafs, and in all kinds of dofes; and, though they generally remained many hours in her body before they were vomited up, they were in no inftance effectual.

Befides ftimulating and oily glyfters, tobacco, in fume and decoction, was injected; and the decoction was alfo, among other purgatives, taken by the mouth.

Glyfters of warm water were daily administered, the patient was repeatedly put into the warm bath, and also had cold water repeatedly dashed upon her limbs and body. She underwent all

thefe