have been necessary to remove the whole scapula along with the humerus, otherwise no flap could have been made of integument not implicated. The patient, however, did not appear at all disposed to take Mr. G.'s advice; and when we called upon him a month afterwards, at his home in Walworth, he was still more adverse to any proposal of the kind.

About six months previously he was seen by Mr. Travers, who declared his opinion as unfavourable to the removal of the disease; but what he judged the affection to be, we cannot positively assert.

In a case of osteo-sarcoma, very similar, but not so bulky, Sir Astley Cooper amputated the whole arm and scapula, with suc

The father of the above man (Hampton,) about 60 years old, exhibited some rare specimens of exostosis on the upper extremities. He had one very remarkable enlargement upon the neck of the right humerus, round, and so much like the configuration of the head of the bone, that there was at first supposed to exist an unreduced dislocation of this latter into the axilla. The motions of the joint were, however, nearly as free as natural, and upon further scrutiny, after seeing this mobility, Mr. Green ascertained the real state of the case. Upon the olecranon of the same arm, another considerable one existed, and also a third of large size near the carpal extremity of the left ulna. There were, moreover, two or three of smaller dimensions on other parts of each fore-arm. The largest were equal in size to hens' eggs. They had all originated in his childhood, or rather infancy, according to the man's own statement, and gave rise to no suffering, nor inconvenience. No increase had taken place in them within his recollection.

BETA.

GANGRENE OF THE FEET FROM FROST BITE, SUBSEQUENTLY REQUIRing AmpuTATION OF BOTH LEGS.

John Wiggins, æt. 39, was admitted into St. Thomas's Hospital, Dec. 15th, 1829. He has followed various occupations during his life time, but has generally lived poorly: he states that about a month ago (having no home) he had lain in the open air during four successive nights, the weather at the time being intensely cold. On the morning after the fourth night, he found himself unable to stand, in consequence of the loss of sensation in his feet. So complete was the loss of sensation that he was totally unconscious of touching the ground. He was in this state conveyed to Cold Bath Fields Prison, as a vagrant, where his diet for some days was gruel and soup, on alternate days. After arriving at the prison, he describes the sensation of his feet as having changed, and instead of the numbness which had before existed, he had a sensation of pricking or stinging heat. This, according to his account, was soon followed by more manifest signs of inflammation, as redness, throbbing, and swelling of the parts. He does not remember what was done for him, but these symptoms, accompanied with great pain, continued for eight days. After this period, the feet were discovered during the night to have become sphacelated; the pain then remitted, the feet became of a black colour, and in different parts slight vesications arose; in a day or two after, a line of separation between the dead and living parts became evident, and with slight variations in his health he passed the remaining time in the prison infirmary, until his admission into St. Thomas's Hospital. His state was then as follows:-the entire sole of each foot, together with all the phalanges of the toes, was in a state of gangrene, being black, dry, and shrivelled; a wellmarked line of separation existed between the living and dead parts, and numerous well-formed granulations had arisen on the former; there was profuse fetid discharge, and he complained of great pain. Pulse 90 and feeble, tongue moist, slightly furred,

appetite good, bowels confined, complains of want of sleep. He was ordered :Pulv. rhei, grs. xv. statim. Mist. camph. Ziss. Carb. ammon. grs. v. Conf. arom. Dj. Tinet. opii, mx. 6tis. horis. To have sago, with 3ij. of Port wine daily, extra meat, and half a pint of porter. Chloride of lime lotion and a poultice to be applied to the feet.

Dec. 16th. He is suffering all the evils of repletion, the nurse having allowed him to take all the above prescribed nourishment at one time. He has had headach, a furred tongue, the bowels have not been opened, and his pulse is 100, and full. His meat was ordered to be suspended for the present, and to have 3iss. of cathartic mixture directly, to be repeated in three hours if neces

sary.

17th. The bowels were not relieved until he had taken two doses of the medicine. The symptoms of excitement have now in a great measure abated. The pulse is soft, though still frequent. The feet are very painful, but the discharge is less offensive.

19th. He still complains of want of sleep, the pulse is improved in power, and his appetite is good. The mixture to be discontinued, and ordered to take opii, gr. j. ter die.

22d. He complained much of the pain in his feet. Granulations have arisen in considerable quantity, and the process of separation is proceeding rapidly, the dead portions being apparently only held by the metatarsal bones.

26th. With the exception of pain he is in every respect improved; and as it is pretty clear that the sphacelated portion is only retained by a slight connexion of bone, sufficient, however, to render the separation by the unaided natural powers unnecessarily tedious, it was determined to remove the right foot. In doing this it was found that the line of separation had passed through the metatarso-phalangeal articulation of the great and little toes; but it was necessary to divide the three intervening metatarsal bones with the saw, near their phalangeal

extremities. With the exception of one or two tendons, which were divided by the knife, the whole sole of the foot was completely separated by absorption-passing in its course directly through the tuberosity of the os calcis-slight hæmorrhage followed the removal, but was immediately restrained by a dossil of lint. A poultice was then applied. He was ordered to take—

Mis!. camph. Ziss. Ammon. carbon. grs. viij. Conf. arom. 3ss. 6lis. horis. Opii. gs. j. sexta quaque horâ.

27th. Has passed a good night, and feels less pain-to continue his medicines and diet. 28th. The left foot was this day removed in the same manner as the former. It was found necessary to saw through the three inner metatarsal bones, and the tuberosity of the os calcis.

31st. Seems to improve rapidly, both the stumps are covered with healthy granulations, excepting the surface of the left os calcis. Medicines as before, and calamine cerate to the sores.

Jan. 4th, 1830. For the last day or two his health has been deranged, and without any apparent cause-his bowels are confined-and on examination of the extremity, a gangrenous spot, the size of a half-crown, was discovered on that of the left side.

Pulv. rhei, c. hydr. grs. xij. statim.

5th. The bowels were freely acted on and the slough, which proved to be merely superficial, has separated.

26th. He has continued to improve up to the present date. The ulcers are cicatrizing slowly, from their edges, and the granulations of the left one are healthy on the right side; they are, however, rather flabby. He

was ordered

Quinine sulph, grs. ij. Extr. gentian, grs. iij. ter in die. Opii, gr. j. ter die. A pint ef porter daily.

Feb. 8th. The cicatrization of the left ulcer has proceeded rapidly, being almost healed, but on the right stump the process is more tardy, the portion of os calcis here exposed seems about to exfoliate.

20th. Little alteration has taken place.

in the patient's general condition, since particular mention was made on this point.

June 1st. The ulceration on the left sole is at present in a healing condition, but not reduced to the small space it has once occupied. Various applications have been used, according to circumstances, and now it is dressed with dry lint and adhesive plaister. Mr. Green has conferred with him about parting with this leg also, as the stump, if ever cicatrized, will be useless, and ever liable to ulcerate afresh. The poor fellow seems unwilling to submit, being in hopes of obtaining admission into Chelsea Hospital as an in-pensioner, in which capacity no bodily labour would be required of him, and he could pass his time comfortably with only one wooden leg. But if he fail in obtaining this berth, he sees the necessity of then losing his limb, upon which, in its present and probable future condition, he would not be able to work, so as to derive any emolument in addition to his scanty pension.

October 20th. The poor fellow has again been admitted into the hospital, with the full determination to lose his remaining limb. The ulceration of the foot has spread, so as to occupy the entire of the inferior surface, and without evincing any disposi tion to take on a healing process. Amputation of the leg, below knee, was accordingly performed on the 7th December. Nothing untoward happened; the stump healed well, and he went out Feb. 14th, 1832, being in a much more comfortable condition with his two wooden legs, than whilst retaining his limbs with the indolent and intractable ulcers. DELTA.

VIII.

COUNTERACTION, VIEWED AS A MEANS OF CURE, WITH REMARKS ON THE USES OF THE ISSUE. By JOHN EPPS, M.D. Octavo, pp. 69. 1832.

THE acute observer, who has published this little pamphlet, hopes that he has been able to throw some new light on the subject of counter-irritation, though most of the facts which he has adduced may be well known.

The proceedings occasioned by the empiricism of Long and his associates seem to have called our author's attention more especially to the subject, and he has prosecuted it with assiduity. Dr. Epps prefers the term counter-action to that of counterirritation, because it may be questioned whether irritation is always the result or the concomitant of counter-action, and, allowing that it did always result, the term, he observes, expresses only one effect, and not the whole of the effects. He considers the subject under three heads-spontaneous, accidental, and artificial counteraction, to which are added, remarks on individual counter-agents, peculiarity of constitutions, &c.

Under the head of spontaneous counteraction, Dr. Epps adduces the cases of eruptions and discharges behind the ears of children, by which the premonitory symptoms of hydrocephalus are removed-those of dentition relieved by cutaneous eruptions on the body-and those indicating approaching apoplexy by epistaxis, the breaking out of ulcers on the legs, &c. Our author pursues his illustrations through the regions of the head, chest, and abdomen, adducing curious and instructive examples of the sanative efforts of the constitution when threatened with disease.

The second chapter is on accidental counteraction, beneficially induced.

Captain Ians, of the royal navy, was tapped, and nineteen pints of water were drawn off. The abdomen began again to fill, and several pints of fluid, so far as could be judged, had re-accumulated. The servant one day, in removing the kettle from the fire, accidentally spilled some boiling water on the captain's leg. Inflammation came

A. B., aged nineteen, has been subject to bad eyes and a discharge from the ears ever since she was fourteen. At twenty, A. B. marries; and, becoming pregnant, the eyes and the ears become well. The children

are either scrofulous or scorbutic, according as the discharge in the mother partook of the one or other character. The pregnancy here acts as a counteragent; in other words, when impregnation takes place, another action-that of formation-is set up in the system. This new action overcomes that on which the discharge from the eyes and the ears was dependent, consequently the discharge ceases.

A child, who was troubled with severe cough of several months' continuancewhose appetite was sometimes good, sometimes bad; countenance first flushed, then pale; became, either from cold, or from the friction of the tightly-tied bonnet strings, afflicted with a swelling, and finally a suppuration, of the glands of the neck. All the previous symptoms passed away, and continued absent as long as the discharge continued."

The counteraction by means of the external application of heat, chiefly by baths, &c. is illustrated by many instances of its powerful effects, but these need not be repeated. Next, Dr. E. proceeds to counterirritants, properly so called, in the form of rabefacients, epispastics, escharotics, and purifacients, as setons, issues, &c. following passage respecting friction is

curious.

The

“It is a lamentable fact, that practitioners are not generally aware of the benefits arising from friction over the bowels in cases of constipation. My plan is to order the bowels to be rubbed with soap lather every night on going to bed. This rubbing promotes the peristaltic action on which the evacuation of the fæcal matter in a great measure depends. I have seen such benefits arise from the plan, that I have no doubt of its efficacy. Hence Sydenham's recommendation of horse-exercise, the beneficial agency of which is, in a great measure, connected with the gentle muscular action, bringing about a state of the circula

ting fluid very similar to that brought about by means of friction."

The work, if widely circulated among the non-professional public, would be very useful in checking quackery, by explaining the rationale of external excitation. The author has keenly exposed the charlatanneries of St. John Long; bnt the public cannot exist without delusion. The liberty of throwing away their money and their health on ignorant and unprincipled quacks, is as dear to John Bull as the trial by jury, or the Magna Charta.

IX.

ON THE EVOLUTION OF THE CHICK, &c.*

WHILE the ovum is yet in the ovarium of the hen, and consists only of the vitellus, or yolk, the rudiment of the embryo may be discovered as a yellow spot, of a lighter colour than the rest of the yolk; if we examine this very carefully, it is found attached to a vesicle, situated under the vitelline membrane, and to which the name of cicatricula has been given. The first six figures in Plate VIII. illustrate this appearance. As the ovum passes along the oviduct, it receives the addition of the albumen, and is subjected to a rotatory movement, arising from the play of the muscular walls of the oviduct, by which it becomes more tapering at its extremities, and in time gives rise to the formation of the two chalaza, by means of which the ovum is suspended and steadied.

Figure very beautifully displays a vertical section of a mature egg, before incubation. Lining the shell, we observe its in

vesting membrane, which consists of two layers, closely applied to each other every where, except at the base or larger end of the shell, where they are separated, and thus leave a cavity, which is filled with air,

* From Carus' Work, "Tabulæ Anatom. Comp. illustrantes."