37

which was greatly contracted, and communi-
cated by dilated ureters with two membranous
pouches, occupying the situation of the kidneys,
the substance of which was completely ab-
sorbed. The patient had suffered from urinary
impediment even when a very young child,
and it is probable that had lithotomy been per-
formed sufficiently early, a cure might have
been effected, but no operation would have
been advisable during the several last years of
his life.

Under Wound, is the fatal case of J. W., a
sawyer, admitted March 24th, for an exten-
sive laceration of the integument of the left
ham; the injury was quite superficial appa-
rently, being merely a stripping off of the skin
from the subjacent parts, and seemed likely to
heal favourably, but deep-seated and wide
spreading suppuration took place, sinuous ab-
scesses formed; the knee joint became carious;
the patient became hectic, and death ensued on
May 18th. Had amputation of the thigh
been performed on his admission, his life might
have been saved, but few would have thought
themselves warranted in doing so, under the cir-
cumstances.—Under general debility is the fatal
case of W. H., a very old man, admitted Oct. 11th,
1859, and died Nov. 5th, 1860.—No fatal
case of Erysipelas occurred during the year.

58 cases of Accident were admitted includ-
ing 4 dislocations and 17 fractures. Two capital
operations were performed, 1 of the forearm, and
1 of the leg; the former was in the case of
W. D., a Taranaki refugee, admitted for
diseased state of the right hand and wrist,
originally caused by a sprain. The operation
was done under the influence of chloroform by
the circular incision, and the patient speedily and
perfectly recovered. The latter was in the case
of W. M., farm servant, who was run over by
a loaded dray and sustained a compound and
comminuted fracture of the right thigh, imme-
diately above the knee. The fracture was set,
and for several days everything seemed to be
doing well, when it was perceived that a dry
gangrene of the foot had supervened. In
the process of time the whole of the foot and part
of the leg shrivelled up and mortified. Mean-
while the consolidation of the fracture went on
steadily, and 7 weeks after the accident the
flap-amputation of the leg was performed be-
low the knee. The patient is still under
treatment. I have to express my gratitude to
several of my professional brethren, military
and civil, who readily gave me their valuable
assistance, on this as well as on other occasions.

Under this head we may notice the case of
W. M., farm servant, admitted with a com-
pound dislocation of his right ankle, caused by
the wheel of a cart passing over it. The foot
was severed from the leg, and the skin
tightly nipped under the lower end of the
fibula. In consultation, one medical man
strongly recommended amputation, but a ma-
jority decided to give nature a fair trial, and
although great inflammation and suppuration
supervened; in seven weeks the wound had com-
pletely closed. There is no doubt that a use-
ful limb will be obtained.

The cases remaining in the hospital at the
end of the year amounted to 41 and are mostly
doing well.

Provincial Lunatic Asylum.

Twenty-three new cases were admitted dur-
ing the year, consisting of 17 Europeans, di-
vided into 9 males and 8 females;—and 6
Maories, divided into 4 males and 2 females.
Of the new cases 10 have been discharged
8 Europeans (4 male and 4 female) and 2
Maories (1 male and 1 female); 1 has died, (a
European male) and 12 remain, divided into 8
Europeans (4 males and 4 females), and 4
Maories (3 males and 1 female). The total
discharged amounted to 12, consisting of 9
Europeans (5 males and 4 females) and 3
Maories (2 male and 1 female). Six of the
new cases were the result of intemperance, and
the remainder seemed to depend on mental and
moral causes—some proceeded from epilepsy
or other disease of the brain. The deaths
amounted to 4:—1st. William Bigg, aged 22
years, admitted with mania, Jan 28th, 1856;
subject to epileptic fits and latterly afflicted
with intractable diarrhoea; died May 12th,
1860.—2nd. Mary Argall, aged 69 years, ad-
mitted Oct. 21st, 1856; sank through infirmity
Sept. 1st, 1860.—3rd. James Fisher, aged 24
years, seaman; admitted May 18th, 1858;
died August 20th, 1860, with every symptom
of pressure on the brain; on examination, op-
posite to an extensive scar on the top of his
head, a large clot of blood was discovered
resting on the surface of the brain; insanity
was clearly the result of mechanical injury.—
4th. James Pridie, aged 39, admitted from
Taranaki April 30th, 1860; had frequent epi-
leptic fits, and was almost idiotic; died Nov.
3rd, 1860; on examination the brain was found
of extraordinary size; its weight amounted to
4 lbs. 7 ozs., being 11 ounces above the average;
its substance was dry and firm, and the cranium
was of remarkable thinness, being nearly
transparent in several parts.

From the breast of one of the female patients,
a cancerous tumour of considerable size was
removed by operation under chloroform—the
patient bore the operation well, and made a
favourable recovery.

Of the 40 who remain, consisting of 33
Europeans (20 males and 13 females), and 7
Maories (5 males and 2 females), little can be
said, most of them have been in the Asylum a
long time, and they are becoming worse rather
than better.

In concluding, I would call attention to the
necessity of enlarging the building to prevent
over crowding, and afford room for other cases,
which are constantly occurring.

Mount Eden and City Gaols.

The prisoners have enjoyed excellent health
during the year, and there have been no deaths.
—One case of typhoid fever was treated in the
town prison, and some cases of scarlatina oc-
curred at the stockade.

T. M. PHILSON, M.D.,
Provincial Surgeon.

Provincial Hospital,
February, 1861.