the patient is threatened with suffocation from the bronchial obstruction in the lungs; under such circumstances we exhibit emetics, but all of these may fail to act on account of the insensibility of the stomach. This state of the stomach depends on lesion of innervation, on asthenia of the organ, and according to some, on determination of blood to another organ, or on imperfect aeration of the blood. I have produced vomiting so often as five or six times, and yet the patient died of suffocation. The profession are much indebted to my friend Dr. Mackintosh, for directing their attention to this disease. My colleague, Dr. Graves, has also made some important additions to the treatment. In one case he applied a moxa along the course of the eight pair of nerves, and in three others, he ordered an enema composed of starch, ten grains of quinine, and thirty drops of tincture of opium. By this means he supported the strength, and prevented the mucous secretion, for it was long known that opium will check the bronchial secretion in common catarrh. I would advise you to peruse his paper in a late number of the Dublin Medical Journal. The last pulmonary disease in fever is pneumonia, which will be detected by auscultic signs, dullness of sound over a greater or less extent of the lung, fullness of respiration, and the respiratory râle. If the patient be robust, the strength but little impaired, the fever inflammatory, the prognosis is more favourable. In such cases one small bleeding may be used; but even this requires great caution; you cannot deplete as in common pneumonia. We next use local bleeding, dry cupping, blisters, and calomel with opium. It often happens that the gums become affected by the mercury in three or four days, but then its effects go off, and in a day or two return. It is also remarkable, that ptyalism is very seldom produced. Tartar emetic is improper in this kind of pneumonia, as it can never be employed, except after copious bleeding, which cannot be resorted to in typhus. There is also another contra-indication to it-the complication of gastro-enteritis; and whenever this exists, tartarized antimony cannot be employed with safety. We, therefore, prefer calomel and opium, local bleeding, blistering, stimulating expectorants, with a nutritious diet. When the surface of the body becomes cool, the pulse weak and small, and prostration considerable, we should use wine. The disease disappears very slowly, the convalescence is tedious, and the patient requires constant watching. [London Medical and Surgical Journal, Jan. 1835.

REVIEWS.

Admonere voluimus, non mordere.

Sunt bona; sunt quædam mediocria, sunt mala plura.

Traité Theorique et Pratique des blessures par Armes de Guerre, rédigé d'après les leçons cliniques de M. LE BARON DUPUYTREN, Chirurgien en chef de l'Hotel Dieu, et publié sous sa direction par M. M. les Docteurs A. Paillard et Marx, 2 tome, pp. 522 and 527, Paris, 1834.

Theoretical and Practical Treatise on wounds inflicted by Arms of War, &c.

FEW surgeons have been so successful in their professional career as M. Dupuytren, and none have acquired a more brilliant reputation. Possessed of excellent judgment, a retentive memory, and great zeal and enthusiasm in his professional pursuits, he added to these qualities, a remarkable penetration, a quickness of perception seldom witnessed, and which admirably fitted him for the investigation of diseases. And for this purpose, no one perhaps ever enjoyed greater opportunities. Entrusted with the charge of one of the most extensive hospitals in Europe; enjoying moreover a large share of private practice, he could not fail to be familiar with the nature, and various forms of disease;— and it was particularly at the bedside of the patient, that his superiority in diagnosis, and excellence as a practitioner, were strikingly manifest.

Among the different classes of disease or injury, which the surgeon is called upon to treat, there is one, the entire knowledge of which cannot be obtained in time of peace, neither in the quiet walks of the hospital, nor in the gradual course of a private practice, but must be sought among the horrors of war, and scenes of death and bloodshed. It seldom falls to the lot of surgeons at home, to have opportunities of witnessing the effects produced by arms of war. The war, however, of 1814-15, and the celebrated revolution of July, 1830, afforded to M. Dupuytren these advantages;-the wounded were received into the hotel dieu, and placed under, his guidance and direction. It was from the observation of these numerous cases of injury, that the principles contained in the work before us were derived; and to these, in fact, it owes it origin. It is indeed a series of lectures delivered by M. Dupuytren, at the request of several physicians and surgeons, as well as students and strangers. The work itself consists of two volumes, the

first of which is taken up with the consideration of wounds in general, without reference to the particular part or region in which they may be inflicted. It is divided into twelve chapters. The 1st is devoted to a description of the different weapons or arms of war, which are in modern use, and contains much that is curious and interesting, particularly to the military surgeon. We shall omit this, however, and pass to the consideration of the effects produced by these agents-subjects with which we are more particularly concerned.

The effects produced by arms of war are exceedingly various, and must depend, of course, upon the nature of the weapon, the force with which the injury may be inflicted, and the nature of the organ or part concerned.

As almost every thing has been applied to the purposes of war, and may be used as a weapon, offensive or defensive, the appearance and the nature of wounds, produced by these agents, vary exceedingly; some inflicting injury, by division of the tissues or by hemorrhage; others by violently bruising or tearing the parts, &c. Hence, M. Dupuytren has made a division of wounds into-"1st, punctured-2d, incised-3d, wounds by puncture and division-4th, contused wounds-5th, wounds by commotion-6th, wounds by crushing of parts, (ecrasement)-7th, lacerated wounds-Sth, wounds par arrachement-9th, wounds by attrition, i. e. such as are caused by bodies propelled by the force of air or steam— 10th, wounds produced by small fire-arms, as guns, pistols, &c-11th, wounds produced by cannon balls, &c.-12th, wounds produced by gunpowder.

In wounds produced par arrachement, there is laceration produced simply by excessive extension; or this may be united with torsion. The cases of limbs torn off by machinery will illustrate this. We have used the word in this place, as its meaning could not be fully expressed by another in English. Under the head of punctured wounds, M. Dupuytren alludes to the effect produced by round and pointed instruments, as bodkins, spindles, &c. The form of the wound inflicted by these instruments seems not to have attracted attention, although, from its singularity and difference of character from that which has generally been supposed, it is worthy the attention of the medical jurist. From several observations made upon the living and the dead subject, M. Dupuytren has ascertained, that wounds made by these instruments are similar, in almost every respect, to those inflicted by cutting weapons. The borders of the wound are even and nearly in apposition, and if they are separated, slight tension of the skin will effect their union;-punctures of this nature always have the same direction in the same region. In the neck, and on the anterior part of the axilla, the direction of the puncture is from above, downward. On the thorax, they are parallel to the direction of the ribs, or the intercostal spaces. On the anterior

part of the abdomen, they are oblique from above downwards, and seem to assume the direction of the muscular fibre. In the middle of this region they are vertical, while on the members they are parallel to the axis of the limb. These facts appear to show, clearly, the different direction of the fibres of the skin in the different regions, and the instrument seems to act merely by separating them.

CASE. "Charles Levauvre, aged 33, strong constitution and sanguine temperament, attempted suicide by stabbing himself three times in the region of the heart with a pointed bodkin. When taken to the hotel dieu, three small wounds of two lines in length were observed opposite the 7th rib. The lips of the wound were equal and very near each other, and the angles of it very acute. They were parallel with the rib, and resembled those made with a penknife. The weapon was procured and several punctures made on the dead subject, which presented the same

appearance.

In wounds of the hollow organs, the injury produced varies greatly, according to the state of emptiness or distension, and our conduct must vary accordingly. Should the weapon which has inflicted the injury be still retained in the wound, (suppose it were the bladder,) the urine should first be drawn off by the catheter, before the weapon is removed, otherwise the sudden withdrawing of the instrument might suffer the urine to escape into the cavity of the abdomen, and produce the most intense inflammation and even death. Should it be in the heart, it would be necessary, in the first place, to diminish the quantity of circulating fluid by v.s. Many cases are on record, of wounds of this organ, in which the patient recovered. Its structure, indeed, is well adapted to secure it against the usual consequence of puncture of the hollow organ, -the loss of blood being prevented by the oblique arrangement of its fibres, as well as their contraction, which is sure to ensue.

In speaking of wounds of the articulations, after enjoining the usual rigorous antiphlogistic treatment, M. Dupuytren recommends the application of a blister around and upon the wound itself; and speaks of this treatment as peculiar to Fleury De Clermont.-It may be new in France, but the practice is familiar enough in this country, and was we believe first recommended by Dr. Physic.

Foreign bodies, although, for the most part exciting inflammation in the organs in which they are lodged, do, it is well known, often remain in the system for years, without producing any or very serious inconvenience. This is the case with some even, which are very sharp and pointed; and of this M. Dupuytren relates a curious instance: "An officer, with a view to commit suicide, inserted in the region of the heart, one of the long black pins, known by name of epingle a friser. This pin penetrated the pericardium and heart, and remained in this viscus

during life time. After death the pin was found, the officer having died of another disease."

In

M. Dupuytren has often had occasion to observe the condition in which foreign bodies exist in the different parts of the body. "Whenever they excite inflammation and suppuration, they are enveloped by a purulent cyst of the nature of mucous membrane, and, at the end of a certain, time, a fistulous communication is formed between them and some point of the surface or interior of the body. On the contrary, when they excite neither inflammation nor suppuration, we find them surrounded by a cyst, the form of which corresponds to their own, but whose organization is similar to those of the serous membranes. their cavity is constantly observed a limpid serosity, analogous to that which lubricates the serous membranes. This remark is not only curious, but important, with regard to practice. If, indeed, in extracting these foreign bodies, we remove them only after making a simple incision of the cyst, and then close the wound, in order to obtain union by the first intention, we find almost always a new tumour produced, by the quantity of serum developed in the sac. It is necessary then, when extracting balls to remove the cyst which surrounds them, or to fill it with charpie, in order to excite inflammation, and obtain adhesion.

But although foreign bodies sometimes remain at rest in the tissues, and give rise to little or no irritation, it is well known that they often travel an immense space of the surface, and even penetrate deeply the interior of the viscera. Particularly does this apply to sharp and pointed substances, as pins, needles, &c. If they traverse the body rapidly, they leave no trace of their passage through the organs. On the contrary, if their passage is slow, they are surrounded by an adventitious serous membrane. In general, they have a tendency from the interior to the external surface. Sometimes, however, this is reversed; but even then there is a strong determination to the interior of the intestinal canal, which in fact may be considered as a continuation of the external surface. It is an interesting fact, remarked by M. Dupuytren, that substances traversing the serous membranes never fall into the interior of these sacs, whereas they frequently, after piercing the serous tissue, penetrate into the mucous cavities. Thus pins which have been swallowed, have been known to pierce the bladder, and being there retained, give rise to the symptoms of stone, and actual formation of a calculus. Of this M. Dupuytren cites an instance. The above cases show a most beautiful provision of nature. We see these substances almost by instinct, as it were, shunning the serous cavities, where they could not fail to excite inflammation, and all its pernicious consequences, and tending towards the mucous surfaces, which either readily allow their elimination, or at least support their presence with less irritation. There is a singular and almost incredible propensity among some females, to swallow pins, needles, and other sharp and pointed bodies. M. Dupuytren has