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rated points of the brain as being in any way implicated, either as cause or effect, in the disease which proved fatal to the patient. He was considered to have enjoyed good health till within three weeks of his death; and till the last twenty-four hours of his illness no symptoms, or assemblage of symptoms, shewed themselves which could be considered ominous, much less characteristic, of disease within the skull. The alteration of structure then, in this case, must have been going on long and imperceptibly before the child began to complain, and consequently was not incompatible with the functions of health.

If then it be satisfactorily shewn that the collection of matter in this case was the cause of death, it points out the important necessity, in similar cases, of making a free incision into all tumours of a doubtful kind near the course of the windpipe.

We may be foiled in our attempts to bring relief, by puncturing such tumours: they possibly may contain no matter; but still unless we be assured that they do not, we are not only authorized, but imperiously called upon to put the matter beyond a doubt by laying them open. The pain and risk of such an operation are not for a moment to be compared with the sudden and complete relief such a proceeding is likely to accomplish.

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In doubtful cases, let us suppose that the chance of failure in laying open the tumour is equal to the chance of saving the patient. What then? How does the account stand? Simply thus out of twelve patients we save six from imminent death at the expense of a trivial, but, as the sequel shews, unsuccessful operation on the other six. And how, but by performing the operation on these six, could it be ascertained (till after death, when it could prove of no avail), that the operation would prove unsuccessful in their cases? Of the necessity of a thorough acquaintance with the surgical anatomy of the neck, to those who would lift a cutting instrument upon it, it is unnecessary for those for whom this paper is intended, that I should make any observations; suffice it to say, that in the case under consideration the common carotid, and consequently the parvagum, and internal jugular crossed the tumour within a line or two of the very point into which, in ordinary cases, it would have been judged the most proper to have thrust the lancet. Notwithstanding this critical situation of these important parts, an intelligent surgeon could have opened the tumour with as little risk of injuring them, as he could open a vein at the bend of the arm without wounding the brachial artery.

Had any account similar to this which I now send you been impressed upon my mind, or had fallen in my way before the

death of my little patient, I am firmly persuaded he would be, among many, a living monument of the triumphs of surgery.

Impressed with a belief that the recital of this case may, perhaps, prove as useful and acceptable to some others, as I conceive it would have been lately to myself, I transmit it without farther apology for insertion in your increasingly useful journal, if you judge it worthy of such a place.

I am, Sir, your very obedient servant,
ALEXANDER PETTIGREW, Surgeon.

Glasgow, 1st July, 1822.

Case of Small Pox after Vaccination directly from the Cow. By WILLIAM SMYTH, Esq. Surgeon of the 45th Regiment now stationed in Ceylon.

Colombo, January 23d. 1820.

We are now familiar with the occurrence of small pox, or at least an eruptive disorder, much resembling small pox, in those who have been previously vaccinated. When the real small pox occurs, it is known to assume a milder character than it would have done had it not followed vaccination. But it is now an opinion entertained by many intelligent enquirers, that a new eruptive disease altogether, has made its appearance both in Europe and America differing from small pox, in attacking indiscriminately those who had been vaccinated, those who had been inoculated, and those who never had either small pox or vaccine disease; in reiterating its attack on the same individual; in the eruption appearing in successive crops; in being vesicular more than pustular, containing lymph only; in drying in horny scabs; in wanting the peculiar odour of small pox; and in there being no secondary fever. Most of all, however, it differs from small pox, in that previous affection with small pox either by infection or inoculation, is no security from an attack of this new varioloid disease. The following case, though less explicit on many of the disputed points than could have been wished, establishes the fact, that an eruptive disease with the leading characters of small pox and succeeding vaccination, has not been confined to Europe and America.

Daniel Cully, aged 19, a private in the Forty-fifth Regiment, was admitted into the Hospital, on November 9, 1819, with symptoms of fever-rigors, succeeded by warm flushing, wandering pains, headache, debility, listlessness, and full bounding pulse.

Mitatur sanguis e brachio, lbj.

et

B Pulv. jalap. gr. xv.

Submur, hydrarg. gr. v.

M. ut ft. bolus, horâ somni sumend.

On the morning of the 13th, an eruption of vesicles made their appearance on the face, neck, chest, and arms. In a few days these became pustular, and much crowded together, but they remained quite distinct without any appearance of confluence. On the 22d, the disease was at its height, and the eruption was

extended to every part of the body. On the cheeks, the pustules were become quite confluent, exhibiting one uniform dark coloured crust. On the 28th and 29th, the incrustations began to fall off.

During the eruptive fever, he had the saline mixture and some other cooling purgative every day; and after its termination, he was supported with tonics, and generous diet. His general strength suffered very severely, and he remains at present in the Hospital, labouring under general debility, with glandular swellings and abscesses on the inferior extremities.

The patient states, that he was, previous to enlisting, a farmer's labourer; and when employed at a dairy in the County of Norfolk, he caught the vaccine disease by infection from the cows, which has left numerous marks on his hands and arms, quite characteristic of the cicatrices succeeding vaccination.

Case of Injury of the Genitals of a Man by the goring of a Bull. Communicated by M. RICHT, of Berlin.

A BULL, which had broken loose from his chain, attacked a ploughman, and piercing his scrotum with his horn, tossed him up, and carried him about for some time, and then threw him with great violence against the walls of the stable. Оп examination, the scrotum was found to he dreadfully lacerated, and the internal skin of the testicles, as well as the septum scroti, entirely laid open and separated, so that both the testicles were wholly uncovered. The horn of the bull had also struck the penis so violently, that a part of the prepuce was turned down over the penis and scrotum. The patient was likewise much gored and bruised in the back and right side of the stomach. Fortunately none of the large blood vessels were injured, and the loss of blood was but trifling.

The first indication was, to endeavour to reunite the wounded parts as soon as possible, to protect the testicles from the irritation of the air. This was effected by cutting away with a scalpel all the lacerated portions of the integument, and after making the edges even, they were brought together and made firm by nature. The whole was then wrapped up with lint soaked in Aqua Saturni. The patient was also ordered to take a solution of Epsom Salts, and to apply fomentations of tepid Aqua Saturni constantly to the parts. This relieved the excrutiating pains, and he passed a good night. The next morning he was very feverish, the stomach was much distended and painful, and the salts had not operated. As an inflammation of the stomach was dreaded, he was copiously blooded from the arm, and several opening enemata and a solution of Glauber's Salts were prescribed.

Several good stools followed from the enemata, and the salts, which removed the distention and pain of stomach. In eight days, the swelling of the scrotum was much diminished, and to appearance the external skin had become sound. There had been altogether very little suppuration, and whatever pus became lodged in the suture was carefully washed out daily. In a few days the suppuration ceased entirely, and by a constant endeavour to approximate the non-united parts, and by the use of the unguentum basilicon, the wounds were healed in about three weeks from the injury, and he returned in health to his labour.

On the Use of Tartar Emetic in Inflammations of the Breast.

In the Revue Médicale Française et Etrangère, there is an account, by Ch. Peschier, of Geneva, of certain cases of inflammation within the chest, success. fully treated by means of large doses of tartar emetic. The author says, that, with him, this medicine has superseded entirely the necessity of bleeding and blistering; and that his practice with it has been eminently successful. He pre

scribes it in doses of from six to twelve or fifteen grains in the twenty-four hours. He dissolves it in a six ounce mixture, of which the patient takes a tablespoonful every second hour, oftener or seldomer, according to circumstances. But he gives other remedies as may be indicated: if the perspirations be too abundant, he adds to his mixture, two drachms of some one of the ethers; if the pain and sleeplessness are very troublesome, he adds one or two drachms of laudanum, the quantity depending on the urgency of the symptoms; and when the inflammation is com bined with strong feverish heat of the skin, he prescribes nitre freely. He has never required to exceed the quantity of fifteen grains of the tartar emetic in the day; that quantity being always found sufficient. The cure is equally rapid and easy; complete convalescence taking place, in the majority of cases, before the eighth day; very seldom does the disease run on to the fifteenth. During convalescence, attention to diet, and to preserve an easy state of the bowels, are all that is necessary. After the second or third dose of the medicine, the patient usually has vomiting; after which there is a great remission of all the symptoms, which, however, is not permanent unless the remedy be continued; for if a dose or two of it be intermitted, the patient directly gets worse; but the effects of the remedy are now confined to the skin and bowels; and it appears that its more disagrecable effects, such as distressing nausea and vomiting, are much less marked, when it is prescribed in this free manner, than when in very minute doses. In these large doses it appears to be equally applicable in all the stages of acute and chronic inflammations of the lungs and pleuræ.

Two Cases of Excessive Dilatation of the Stomach, with Dissections and Remarks, by M. ANDREL, Fils, M.D.*

In the month of March, 1822, a woman, aged 65, apparently in the last stage of marasmus, was admitted a patient into the Hospital of the Charity. She had been affected from the month of June, 1821, with the usual symptoms of a dyspeptic affection, which had increased daily in severity. When admitted, the size and figure of the stomach, occupying the greater part of the abdominal cavity, could be perfectly ascertained; its lower edge rested upon the pubis; the upper curvature, at the centre was on a level with the umbilicus, from which it ascended towards the right hypochondrium. She felt constant pain in the region of the pylorus, subject to occasional aggravations. After admission she vomited almost incessantly for the space of forty-eight hours, a brownish liquid; the size of the stomach then diminished in some degree. The vomiting took place almost without effort; it rather resembled simple regurgitation, at least at the commencement. Her desire for food was frequent; but a few morsels satiated her, and these caused an insupportable sensation of bitterness in the mouth. She had constant acid eructations, Her tongue was clean, thirst moderate, pulse feeble, stools seldom, and the skin dry, but without heat. She died on the fifteenth day from her admis sion, preserving her intellectual faculties to the last. On DISSECTION, twenty-two hours after death, the stomach was found filling nearly the entire cavity of the belly; its larger curvature was partly concealed behind the pubis; it rested on the uterus, and stretched obliquely into both the iliac fossæ; from the right it ascended towards the right hypocondrium, where it terminated in the duodenum. The whole of the intestines were concealed by this immense stomach, except a few folds in each lumbar region; its cavity contained a quantity of brownish fluid, resembling that which she had vomited. Its internal surface was perfectly white, and the mucous membrane soft. But there was no mucous membrane for the breadth of four

* Journal de Physiologie, &c. par F. Magendie, &c. Number for August, 1822.

fingers towards the pylorus, and at the point where it ceased to exist, it formed an irregular whitish eminence. An ulcerated surface now succeeded, with great thickening and hardening of the parts, which, when cut into, shewed no vestige of muscular fibre, but appeared of a pearly white colour. The opening of the pylorus admitted the extremity of the index finger easily. The calibre of the intestinal canal was found contracted, but otherwise there was no morbid change of it.

The opening in the pylorus, when there has been no disease, is found quite shut in the dead subject; and it is found, by experiments on living animals, to be the same in them. The functions of this opening are performed in a manner analagous to those of the sphincter muscles of the bladder and rectum. When digestion is finished in the stomach, the muscular coat contracting, overcomes the resistance of the pylorus, and the chyme is transmitted into the duodenum. But when, as in this case, the pyloric portion of the muscular structure of the stomach becomes changed by disease, contraction does not take place in a perfect manner; the chyme consequently is not transmitted through the pylorus, even though the pyloric opening be much larger than it is in health. It was so in the preceding case. If a small quantity passes, when the stomach is filled, it is rather like the overflowing, which sometimes happens in paralysis of the bladder, than like a perfect transmission of the chyme. The other case of distension, however, seemed to depend on a different cause. The patient had all the symptoms of a schirrous pylorus, or of a chronic gastritis, though it was found that she had neither of these. A woman, aged 23, an instructress, having been reduced in her circumstances, left the country and came to live in Paris, where she taught incessantly in a little school. She soon became affected with dyspeptic symptoms. In February, 1821, she had a severe and protracted fainting fit, after which she became subject to occasional vomitings. Her health, in December following, began to decline ra pidly; she gave up her employment and became a patient in the Hospital of the Charity in February, 1822. She was in the last stage of marasmus; her skin discoloured; she vomited food as well as drink, more or less immediately after swallowing them; she had trifling pain at the scrobiculus cordis; the tongue was natural, respiration free, bowels habitually slow, and the skin dry and without heat. On the 12th of March all the symptoms were aggravated, the pulse had become quick; she died on the 14th.

DISSECTION twenty bours after death. The stomach was so much dilated, that it covered the whole of the abdominal viscera, except a few folds of intestine at each side; its colic edge was as low as the pubis; it was its greater cul de sac, which was more especially enlarged. There was a slight reddish tinge of the internal coat, which was less manifest towards the spleen than elsewhere. The coats, more especially the muscular one, were exceedingly thin and easily torn. The small intestines were much contracted, and the descending colon in a very great degree. The larger intestines, at different points of their mucous coat bore evident marks of inflammation; they were impacted with hardened matter. The liver was somewhat enlarged though otherwise sound.

Some authors have described similar cases with the above, under the title of dropsy of the stomach; and Bonnet relates one where the swelling being mistaken for an ascites, paracentesis was performed, and death followed. In the CASE last detailed, there was no disease of the pylorus, or of the stomach to account for the dilatation. Lieutaud relates a CASE, and ascribes the distention to palsy of the stomach; but in his case the patient had no vomiting; hence he infers, that vomiting is performed by means of the muscular coat of the stomach. M. Andrel supposes that the last case depended upon paralysis of the muscular coat, although there was vomiting. When the stomach is so strongly distended, very slight pressure of the abdominal muscles may cause vomiting. There is a strong analogy between distension of the stomach from paralysis and that of other organs.

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