ABSCESS OF THE LUNG COMMUNICATING WITH THE SUrface. A YOUNG man, aged 16, of a delicate and scrofulous constitution, had for many years been troubled with enlarged cervical glands. Two years ago, an abscess, situated in front of the trachea, and below the upper end of the sternum, made its appearance; it broke, healed, and broke again, leaving a fistulous opening on the fore part of the neck. At the same time several strumous abscesses formed on the thighs; and he had always a cough which was worse during cold weather. The discharge from the neck abscess was checked; and immediately afterwards the cough was aggravated, Dissection. The two openings of the neck led inwards to an abscess seated between the sterno-mastoid muscles, and between the superficial and deep cervical fascia. At the lower part of this abscess was found an aperture, which proved to be the extremity of a fistulous passage, which led deep into the chest, through the texture of the lungs, till it reached the upper portion of the inferior lobe, and there it opened into an abscess of an inch and a half in diameter; the abscess was empty, its walls smooth; two or three bronchial tubes opened on its surface; the situation of this abscess was on the superficial or most anterior portion of the lung, and separated from the triangularis-sterni muscle, only by a very thin layer of pulmonary substance. The rest of the lungs was nearly normal, and quite free of any tubercular deposit. Other viscera sound. Remarks. The above must be regarded as an instance of simple abscess unconnected with any softening of infiltrated tuberculous matter.-Ibid. XX. CASES OF SPONTANEOUS GANGRENE. A MAN, aged 61, of a sound and strong constitution, was admitted into the Hôtel Dieu; there was an immense phlyctena, covering the lower third of the left fore-arm; the ring and small fingers on the right side were similarly affected; the skin around these vesicles was red, but in other parts of the limb of a purplish colour, and gave out a peculiar gangrenous smell. When the raised cuticle was removed, the subjacent surface was at first reddish, but subsequently became of a slaty colour, and then black; he could assign no cause. The sores were dressed with chloruret of soda, and healed slowly in the course of three months and a half, during which time he took tonics largely. Case 2. A water-carrier, æt. 73, had, for five days preceding his admission into the hospital, noticed a swelling on the right cheek, which appeared spontaneously. Five leeches had been applied; gangrene had followed, and now the eschar had reached from the malar bone to the lower jaw, and from the mouth to the masseter muscle; this side of the face was quite paralytic-great general prostration. He was ordered cinchona, camphor, and musk, and the sores were dressed with chloruret of soda; in time, the whole thickness of the check had sloughed off, exposing to view the inside of the mouth, and speedily he died. No assignable cause could be traced. Ibid. XXI. CASE OF POISONING. some "theriaque;" but the next day she died. On dissection, the alimentary canal was found violently inflamed, and there were several black patches on the stomach; the contents were carefully collected, and submitted, several days after the death of the patient, to Prof. Fodéré for examination. He remarked their extreme fætor and putridity, and, from this occurrence, was led to suspect the presence of a narcotic poison, having always observed that such was not the case when any metallic and acrid poison had been swallowed. So exceedingly offensive were the contents on the present occasion, that M. Fodéré, although much accustomed to enquiries of this sort, could not remain in the laboratory till it was purified with chlorine gas. Before we state the particulars of the analysis, it is proper to allude to some of the appearances during life and after death, viz. the extreme dilation of the pupils, the cerebral congestion, the congested state of the bronchia, from which it was at first suspected that the leaves of conium might have been mixed in the salad with the chervil. The contents of the intestines, after being filtered, were carefully evaporated, and tested with sulphuretted hydrogen, nitras argenti, sulphas et ammoniuretum cupri; but these agents produced no changes. On exposing the collected deposit from the filter to heat, in a platina crucible, no odour, except that of animal matters, could be perceived; all traces of a garlic or arsenical smell was absent. Having now ascertained that there was no traces of mineral poison, our attention was directed to ascertain if any vegetable one had been swallowed; another portion of the fluid contents was taken, and part of it treated with alcohol, part with a weak solution of muriatic acid; the fluids were then filtered. On adding oxalic acid, traces of lime were found, and muriate of barytes shewed the presence of sulphuric acid. When liquor potassæ was added, a lixivial and ammoniacal odour was disengaged, and a gelatinous or glairy precipitate, which remained in suspension through the fluid, was occasioned. When carefully filtered, the [Reported by Professor FODERE.] FIVE persons had dined off soup made of dry pease, lard, and pork sausages, and afterwards they had eaten some dried chervil; they experienced no bad effects. The supper consisted of the remainder of the soup, which had been kept in a cast-iron vessel; and no sooner had they partaken of it than all were seized with violent symptoms, viz. vomiting, intense thirst, burning and sharp heat in the throat, stomach and bowels, great lassitude, and headach; some were also purged. It was found that, on giving some of the soup to a moderatesized dog, it immediately vomitted. The five persons continued to be more or less indisposed for several days; one, a female, became worse on the sixth day, and then consulted a midwife, who administered precipitate was collected from the filter and dried; it was white, confusedly crystallized, and of a salt and bitterish taste. On adding a few drops of nitric acid, the colour changed from white to red, and then to yellow, as is the case with morphine, brucine, strychnine. It was therefore suspected that death had been occasioned by the "theriaque," or opiate electuary; and it was, therefore, desirable to ascertain if there were any traces of its presence in the alvine contents: as iron is the best test of opium from its striking a blood-red colour with it, we added a few drops of a solution of murias ferri on these, previously diluted with distilled water, and the characteristic change of hue was directly perceptible. On testing the substance which had been obtained by the first process, and which by becoming red on the addition of nitric acid, was suspected to be morphine, with the same ferrugino is salt, no change was effected; it became, therefore, a question, whence had this proceeded? and we are still left to suppose, that the opium of the theriaca may, probably, during the putrefaction, become decomposed, and the morphia be thus separated from the meconic acid. Unfortunately, none of the soup was preserved for examination; and, as some theriaca had been administered as an antidote to the person who died, much uncertainty hung over the case. Besides the greasy matter of the "charenterie," or pork sausages contained in the soup, might have acted on the metallic vessel in which it had been kept; and, accordingly, the hydrocyanate of potass detected the presence of iron. The conclusions which Fodéré draws from the preceding case, are the following, and deserve attention, as being applicable to many cases of suspected poisoning. 1. That the professional person who was first summoned ought to have examined the quality of the dried chervil, and ought to have saved for future examination the remainder of the soup; he ought also to have stated the age, previous health, and habits of the patient. 2. That the five persons who had partaken of the soup, had certainly suffered from some poisoning; but that the soup did not contain any of the mineral poisons, which are usually employed for criminal purposes. 3. That it is probable that the accidents depended on some spontaneous changes which the soup underwent, while kept in the metallic vessel. 4. That the death had been promoted by theriaca, which had been improperly administered, not, indeed, with the intention of murder, but certainly in contravention of the law of "19 Ventôse, et 21 Germinal," by the midwife, who had been applied to for the purpose of recommending a medical man to the patient. One remark more :Two of the persons had eaten milk and potatoes after the soup an chervil, and these two suffered less, which accords with what Fodéré has mentioned in his "Legal Medicine," that farinaceous, mucilaginous, and emollient substances, swallowed before or after a poison, remarkably assuage their deleterious effects.-Journ. Complem. XXII. CHOLERA, GREAT VARIETY IN THE TREATMENT OF, IN PARIS. We have regretted that we have not noted down each and every mode and method which has been recommended in this country; it would form a document at once curious and instructive, at least so far as in shewing us, how the monster has laughed to scorn all the futile attempts to arrest its fury; and how frail and feeble are the grounds on which the practice of medicine, in the hands of many, is founded. No one, we think, will dispute with us, that the only rational hope of successfully treating this, or any other disease, is by a comprehensive and philosophical scrutiny of its physiology or symptoms during life, and of its pathology, or its appearances after death. We must not look to one, or to another of these singly, but group them together, and cautiously endeavour to trace every link of the chain; it is only thus that we can expect to arrive at any rational conjectures as to the causes and essence of the disease; and till then, the treatment must necessarily be empirical, and on the whole, perhaps, as inefficacious, nay, even decidedly hurtful, as beneficial. If, in any future period, a method of cure, at once successful and generally applicable, be discovered, we, or our successors, must look back to the records of this disease, with feelings of little respect for the soundness and sagacity of the present race of medical men; for we have all along permitted ourselves to be too much carried along by an exclusive or undue attention to one particular phenomenon, and on that, as on a pivot, we have made our practice turn; but it is never too late to be wise, and our wisdom will be best displayed, by endeavouring to draw some useful lessons from the blundering errors we have hitherto committed. Some idea may be formed of the malapraxis of the French physicians, from the following report of the different plans of treatment of the cholera in the various Parisian hospitals. Hóp. Necker-M. Bricheteau. Vapourbaths, aromatic infusions-general and local bleedings, sinapisms and stimulating embrocations-wine, æther, and cordials -emetics, cold lemonade, iced water, effervescing draughts, ice laid on the epigastrium, opiate enemas, opium pills by the mouth. In less severe cases, energetic antiphlogistic treatment. Hóp. Orphelius-M. Blane.-Bleeding, emetics, effervescing draughts, purgatives, and then astringents, if the purging is obstinate-iced drinks. Hóp. Piepus-M. Patrix. Fumigation with chlorine-bleeding-emetics-narcotic decoction-iced lemonade-blisters on each bypochondrium. Hop. St. Antoine.-M. Mailly. Leeches to the anus and epigastrium-venesection, antispasmodic and opiate drinks-stimu lating frictions-infusion of peppermint, with acet. ammoniæ. Hóp. St. Louis―M. Biett. Subnitras hydrargyri―charcoal, in doses of 3ss. every hour. M. Lugol. External warmth―æther, with laudanum and acet. ammoniapills of acetas morphiæ. For drink, strong tea, well sugared, acidulated, and alcoholised! against the vomitings, seltzer water, either alone or with wine. M. Gerdy. General stimulating frictions -blisters along the spine-sinapisms to the arms, legs, and epigastrium-gaseous, laudanised potion-pills of camphor. M. Jobert. Sinapisms along the whole extent of all the limbs-laudanumleeches to the anus. When vomiting is obstinate, seltzer water, or the withdrawal of all drinks. Hop. Salpetrière-M. Piorry. General or local bleeding-hot aromatic infusionMalaga wine or light punch during the collapse-iced water, and, when re-action ensues, leeches, poultices, and gum drinks. Hop Pitié. Fresh lemonade or warm tea-peppermint and laudanum, opiate enemata. M. Andral employs ipecacuan emetics-excitants during the cold stage -local and general bleedings during reaction-opium in small doses. M. Lisfranc. Tea, lemonade, and punch -enemata, with sulphate of quininesinapisms and stimulating frictions. M. Velpeau. Sinapisms, opiates, quinine enemata, to which are added laudanum and camphor. M. Bouillaud. Bleeding, leeches to abdomen, frequently repeated-iced lemonade. In the state of complete collapse, weak coffee as a drink, and drawing a heated iron along a flannel band, which has been well soaked in equal parts of liquor ammoniæ and spir. tereb. and applied over the whole length of the spine. Val de Grace M. Broussais. When there is profuse vomiting and purging, the patient should be given ice alone to swallow: when the state of cyanosis ceases, we ought to substitute drinks. No frictions should be employed. General bleeding, or, what is better, numerous leeches, and afterwards hot poultices to the leech-bites -sinapisms, vapour baths-leeches and iced water to the head. Journ. Complément. The simple treatment of Broussais coincides nearly with the cold-water practice in this country.-ED. XXIII. CHOLERA ANECDOTES. A GENTLEMAN, recently returned from Paris, informs us that it was most amusing to study the French character, when cholera made its first alarming onset in the metropolis. The eafes were crowded with persons, of all descriptions, calling for "punch à Majendie;" nothing else was drank, and many a severe griping belly-ache was the consequence ; but, in addition to this punch, every one took to cigar-smoking, and you might see in the streets, as you passed along, those who had not served their noviciate to the practice laying hold of any rails or balustrade, and retching and vomiting after every whiff; yet they must nobly persevere, for nothing was so effectual a preservative as smoking, they were told. If any looseness came on, it was often no easy thing to aseertain, whether one of these "jeunes hommes de tabac" were really affected with cholera, or only with the effects of the smoke. So great was the demand for cigars at first, that our friend for some days could not obtain one, at a dozen or more shops where he applied. XXIV. CHOLERA. UNWILLING though we are to occupy space with details of cholera, we consider it most useful to avail ourselves of any document or reports, which tend to throw light on the history of its propagation. Few, if any, are now so hardy as to maintain that it is by contagion, and by that alone, that the pestilence has spread from India's shores to inland America; such dogmatism would not be tolerated as the opinion of a sane mind, but we ought equally to avoid the other extreme, of stoutly denying the possibility of its conveyance from one patient to another, and of shutting the ears of our minds to any arguments advanced on the opposite side of the question. The zeal and anger of partydiscussion has blown over, and we now can quietly look back on the introduction of cholera into this, or any other country, as we should do upon any historical event, and dispassionately weigh the probabilities of its origin. It is, indeed, very gratifying to us, that the views which we almost alone maintained, against a battery of numerous assailants, appear now to be those of all the rational members of the profession; they have even been embraced by the very men who, at one time, most vigorously opposed them: but such is, and ever will be, the triumph of calm and impartial truth, and the only merit we assume to ourselves, is that of considering both sides of the hotlycontested question, with a fair and unbiassed mind-of studying the history of its progress from the East to our own shores, and of comparing the opinions and statements of others with our own experience, both abroad and at home. An argument at once philosophical and important, on the question-" Is cholera essentially contagious or no?" may be drawn, we think, from the undeniable fact, that long, very long, before the acknowledged irruption of the disease into any country, it had given, as it were, a colouring of its own, or a peculiar and unusual character, to other existing diseases. We shall select a case or two in proof from a paper by Dr. Sabatier, of Paris, published in the Journ. Univ. et Hebdom. It was observed by all the medical men there, that for six or eight weeks previous to the occurrence of the pestilence, there was a very general tendency, in all diseases, to be accompanied with an extreme |