irritability of the alimentary canal, occasioning vomiting and diarrhoea. In the month of January, M. Baudelocque observed in two children, affected with smallpox and pneumonia, that the tongue was as cold as it ever is in the collapse of the cholera. The following very anomalous case exhibits other analogies.

A boy, aged 15, of a strong healthy constitution, residing in the Rue-Saint-Germain, was brought to the La Ch é Hospital, on the 25th October, 1831. Four days previously he had become indisposed, complaining of pain in the left fore-arm, of general weariness and debility. On the 24th, the pain of the arm was much worse-he was very restless, occasionally delirious, and then very heavy and stupid the light incommoded him. Profuse vomiting now came on, and also convulsive twitches of the whole body; alternately he was calm and agitated—at one time sitting up and answering questions, at another throwing himself on the floor, making strong efforts to vomit, and struggling violently: the action of the heart and carotids was powerful-pulse 138, sharp-respiration every now and then interrupted by a spasmodic contraction of the muscles of expiration, to force out the saliva which dribbled from the mouth. At times he was threatened with a feeling of suffocation, and experienced a very acute pain under the ensiform cartilage -bowels obstinately costive; symptoms of hydrophobia came on-the vomiting and ptyalism increased. Bleeding and opiates were employed, but nothing could be retained on the stomach, and soon after he was incapable of swallowing; still his consciousness and intelligence were unimpaired. But a great change quickly followed, and he sunk into a state of extreme exhaustation, and died in the afternoon of the day upon which he was admitted.

Dr. Sabatier alludes particularly to the obstinate vomiting, to the rapid sinking of the features, to the retention of the mental powers, even after the patient had become icy cold, and to the sudden annihilation of the pulse, as approximating the disease, in

INGENIOUS METHOD OF APPLYING NITRAS ARGENTI TO ULCERS OF THE CORNEA, &c. &c.

TAKE a silver female sound, or large silver probe, and heat an inch of its extremity in the flame of a candle; then rub lightly upon it a stick of the lunar caustic; the salt is immediately melted, and unites with the metallic surface, coating it with a thin layer of caustic; if it be too thin, we have only to repeat the same process. When the instrument cools, it must be wiped clean, and then it is ready for use.-Ibid.

XXVII.

CONTAGION Of Disease.. DUPUYTREN states that he has repeatedly observed, that diseases assumed a contagious, or at least a spreading character,

when more patients than the regular and proper number have been admitted into the wards of a hospital, and that the calamity has been at once arrested when these were thinned, and the ward was sufficiently ventilated-Ibid.

XXVIII.

RHINOPLASTIC OPERATION.

A FRENCH Soldier, at the battle of Waterlao, had his nose clean cut off by a sabrewound, the upper lip was also divided, and five of the front teeth, with a portion of the alveolar process of the upper jaw, knocked out; but hero-like, as all Frenchmen are, he pursued his opponent, an English soldier, and had ample vengeance we are told. The wounds healed, and for several years he wore an artificial nose of silver, and afterwards one of copper, by both of which he was much annoyed. He was persuaded by a surgeon at Rouen to submit to an operation, which consisted in dissecting a flap from each cheek, and uniting them along the bridge of the nose-to-be. But the deformity was greater than ever. M. Blandin was now consulted; he performed his rhinoplastic operation, hy dissecting the flap from the skin of the forehead. The artificial nose united very favourably, and even withstood an attack of erysipelas, which spread over the face, a month after the operation. It is to be remembered that M. Blandin does not ever detach, or cut through the pedicle of the flap; it is, therefore, obvious that this portion cannot very easily, or possibly become attacked, in consequence of its having been necessarily twisted on itself, when reflected down, unless some ulterior pruning and embellishment by the scalpel be resorted to. Other surgeons have divided the pedicle, when the rest of the flap has become firmly united; but M. Blandin does not approve of this, and prefers the following process:-With a scalpel he pares the already cicatrized edges of the pedicle and also the surface of the corresponding integuments, which cover on each

sid the nasal processes of the upper maxillary bone; these raw surfaces are then carefully applied to each other, and retained in this position by a compress and bandage.

The cure in the above case was most satisfactory, or in the words of our Continental brother, "it was a nose, a true nose-such a nose as is seldom to be seen (we believe it)—a regular, nay, even almost an elegant nose !! and one for which many of my acquaintances would gladly have exchanged their own; and not such a hideous stump or appendix as M. Delpech, and M. Lisfranc, and others, have grafted on the faces of their unfortunate patients ! !”— These latter operators, we are informed, have always divided the pedicle of the frontal flap.

The advantages of preserving the original attachment of the pedicle are manifold; the nutritious vessels are preserved, and the life of the new nose is, therefore, much stronger; the skin, moreover, retains its natural colour, and does not become purple, as has been the case after most operations; besides, the tip of the nose is prevented from falling downwards on the upper lip, and thus closing up either one or both nostrils, an accident which has frequenty happened, and caused much annoyance both to patient and surgeon. It may be supposed that, in M. Blandin's method, an awkward or ugly button, or protuberance, must remain at the point where the pedicle is twisted; this is a mistake, for it gradually wears away, and no deformity remains.

Perhaps it is not generally known that, if we blindfold a patient a few days after a rhinoplastic operation, and the new nose be pricked, he will refer the sensation to the forehead; but when the union becomes perfect and complete, the mistake is no longer committed; this, therefore, may perhaps be taken as a test of the proper time at which the pedicle should be divided, if the operator determines upon that.—Ibid.

XXIX.

ON THE CHANGES WHICH THE POINTS OF THE FINGERS UNDERGO IN PHTHISIS, &c.

HIPPOCRATES remarked that, in those who died of pulmonary consumption, the nails became bent-" phthisitis ungues adunci ;" the assertion used to be called in question by many medical authors, but M. Pigeaux, who has directed his attention to this subject, and written "a memoir on the etiology, symptomatology, and the mechanism of the fusiform developement of the extremities of the fingers," fully confirms the truth of the aphorism. He examined the hands of 200 phthisical patients, and found that 167 of these were provided with "griffes Hippocratiques." Every tubercular patient does not certainly present this phenomenon, but in other diseases of atrophy the proportion is much smaller, not exceeding one in ten; it appears therefore, that a certain relation may be traced between thoracic maladies and the curving of the nails, although it occurs in other diseases, but certainly not so frequently. In 183 cases of diseases, not tuberculous, which had produced great emaciation, 17 exhibited the phenomenon of the curving of the nails in a very remarkable degree; of these 17, nine were cases of organic affection of the heart-four of emphysema-two of asthma and catarrh, and two doubtful. An obvious dyspnoea existed in 13 of these cases, and also in almost every one of the 167 tubercular cases. I have no doubt that some connexion may be traced between all such maladies as create an impediment to the respiration or circulation, and the appearances of the nails alluded to, or, at least, between the former and the fusiform swelling of the last digital phalanx, with which the curving is generally associated. In 20 of the 167 tubercular cases, the patients had not lost their embonpoint. After many examinations into the cause of these phenomena, I am satisfied that the change in the points of the fingers precedes, and is the cause of, the curvature of the nails. Now this change consists chiefly in

an oedematous infiltration of the pulp of these, by which the nail becomes mechanically forced out and forwards, and thus its end is curved round. As a general rule, it may be stated that the fusiform developement of the last phalanx of the fingers, with the curvature of the nails, is generally indicative of the presence of tubercles, or of any derangement of sanguification. If we notice particularly the change of form, we find that the swelling begins at the articulation of the 3d with the 2d phalanx-that it increases somewhat towards the root of the nail, which becomes the most projecting part, and then it tapers off to the end of the finger: the thumb and fore-finger are generally affected first. The progress of this affection does not depend so much on the "phases" " of tubercular disease, or of organic affections of the heart, as on the influence which these have on the general state of "hematosis" and of respiration. I have observed it to increase, diminish, and even to vanish, with the removal of the cause which had produced it. It is more common in women than in men; it is much more rarely seen in the toenails, with the excep tion of that of the great toe, the swelling of which, and the consequent "growing of whose nail into the quick, often gives rise to much pain and annoyance." To impress his readers with the importance of the above appearances, as symptoms, the author says that he has, by attention to this particular, repeatedly been enabled to fortell the severity and danger of a pulmonary catarrh, of a pneumonia, &c. which were supposed to be of an innocent nature! he, therefore, regards it as a very unfavourable sign; it exists, he says, in six-tenths of consumptive patients, and, on the whole, it is more frequently seen in those who still retain their embonpoint, than in those who are much emaciated. If the above remarks be confirmed by experience, it must be considered as a valuable adjunct in guiding our diagnosis. The anatomy of this change will be readily understood from what has been stated above; the nail, separated from the finger, appears very little, or perhaps not at all curved; but

when in sitû, it is found to be elevated and pushed forwards by the infiltrated pulp underneath; the bone is not altered.-Archives Générales.

We do not vouch for the entire correctness of the preceding details, but deem them well worthy of attention by all enlightened physicians.-ED.

XXX.

CASES OF DISEASES OF THE KIDNEYS.

THE history of the pathological states of the kidneys is still very imperfect; the late Dr. Dance, who died a few months ago of cholera, one of the physicians of the Hôtel Dieu, at Paris, left some manuscript observations on this subject; from these we select the most interesting.

Case 1. NUMEROUS CALCULI IN THE SUBSTANCE OF THE KIDNEYS; DILATATION OF THE Infundibula and Pelvis, which

WERE ALSO INFLAMED.

A girl, aged 23, entered the hospital on the 12th January, 1824. Two years and a half before, she firet voided some blood with her urine, and felt severe pains at the time in the loins. The urine was muddy, thick, and afterwards whitish and purulent, and scanty in quantity. These symptoms continued more or less for 18 months, at which time she experienced a feeling of great weight and heaviness in the renal region, and the urine still deposited the same puriform matter, but there was no sand or gravel mixed with it. Three weeks ago the catamenia were suddenly suppressed by exposure to cold, and from that period she has been very ill, complaining of great pain and tenderness over all the abdomen and in the loins; thirst, nausea, urine voided with much pain, and only in small quantities. Leeches were applied to the anus, and an emollient ptisan ordered. The severe pains of the abdomen were relieved, but those of the kidneys became worse and worse. Vomiting, pulse weak and feeble, facies hippocra

Dissection. The kidneys were found larger by one third than usual, embossed on their surface, hard and resisting to the finger in some places, and fluctuating in others. On dividing them, the scalpel grated against numerous calculi nicked into the substance of the kidneys, and jets of pus escaped at the same time from many points. Nine calculi were found in the left kidney, and 15 in the right; each of these was contained in a sort of cyst, lined with a mucous membrane, and was bathed in purulent matter. These cysts were the dilated calices and infundibula. The calculi varied in colour, being white, yellowish, or ash-coloured; many were of the alternating sort, and consisted of numerous layers of uric acid, and ammoniaco-magnesian phosphates. proper substance of the kidneys was much wasted; the ureters were greatly thickened; bladder small, and its texture indurated; its mucous membrane affected with chronic inflammation.

The

Case 2. ACUTE PARENCHYMATOUS NEPHRITIS, WITH SYMPTOMS SIMULATING THOSE OF MALIGNANT AGUES-SPEEDY DEATH.

A mason, æt. 35, had for three weeks suffered from a severe fixed pain in the renal region, which had been preceded by an oedematous puffiness of the lower extremities. No cause could be assigned for the attack. On admission, the renal region was found to be swelled and resisting to the hand; the whole abdomen was so tense, as to preclude an accurate examination; the countenance expressed great anxiety, the pulse small and rapid. Venesectio; blood inflamed. The symptoms were not relieved; the tongue became red and dry; the lumbar pain extended round to the epigastrium ; and the urine was voided frequently and in small quantities; no sickness or vomiting; no pain nor retraction of the testicle, not numbness in the groins. Shiverings, horripilation, and other symptoms of the cold stage of fever came on; he was copiously bled; the pain of the kidneys not abated.

For two or three mornings successively a similar febrile paroxysm recurred; the urine became of a blackish colour, but deposited a white sediment.

On the 6th day after admission, the patient was much worse; features greatly altered; breathing difficult, and severe pain in the epigastrium and region of the kidneys. The quotidian paroxysms begin with violent shiverings. Two days afterwards he died. Dissection.-Head; three or four spoonfuls of serum in the ventricles. Chest. Lungs gorged with a frothy fluid. Abdomen. Left kidney quadrupled in size; at its upper part was a small abscess, between its tunica propria and the cortical substance, which was of a brown and purplish red colour. Numerous small abscesses, varying in size from that of a pea to a hazle-nut, scattered through the texture of the kidney, but found chiefly near to its surface; here and there the pus appeared to be infiltrated through the renal tissue, which had become much softened and converted into a flaky detritus; its colour was generally a reddish-brown, but marbled with white points of suppuration. These morbid appearances were most conspicuous in the cortical substance. The pelvis was sound, and also the corresponding ureter. The right kidney was wasted, of a firm resisting texture, and not exceeding in size a hen's egg; its surface was irregularly undulating and embossed, as we observed in the fœtal state; pelvis and ureter healthy and quite permeable. Bladder contracted on itself; half filled with a thick muddy urine, like a decoction of

bran.

Remarks. The preceding case is one of inflammation affecting the parenchyma of the kidneys, and not as in ordinary nephritis, the mucous membrane of the pelves and infandibula. The symptoms, with the exception of the fixed and severe pains in the loins, very much resembling those of a malignant intermittent, or perhaps rather, remittent fever; the quotidian aggravation was very remarkable. Physicians should attend to this.

Case 3. HYPERTROPHY AND RAMOLLISSEMENT OF BOTH KIDNEYS, GIVING RISE TO GENERAL DROPSY.

A female, aged 32, stated that she had been, for 18 months, more or less affected with dropsy of the legs and belly. No cause could be assigned. The heart was deemed sound, upon auscultation; there were no palpitations or dyspnoea,-could lie easily in the horizontal posture. A constant dull pain in the right hypochondrium; with the exception of this the patient complained of no other uneasiness. Urine thin, limpid, and very scanty; thirst moderate, pulse small. The disease increased in spite of diuretics, and she died suddenly and unexpectedly a month after her admission. Tho symptoms were altogether of a negative nature.

Dissection.

Cellular texture loaded with serum. Half a pint of effusion in each pleura. Lungs and heart healthy. Several pints of serum in the abdomen. Liver healthy, although it was of a colour somewhat yellowish; other viscera sound, except the kidneys, which were greatly enlarged, and also softened in texture; their colour was that of yellow wax, the tunica propria adhered very loosely to the cortical substance; which was the structure chiefly affected, the tubular portion appearing healthy; the contrast between these two was very marked; by scraping with the finger, and having a stream of water to play on it, the whole of the former might be washed away, so soft it was, while the central medullary part was left. The infundibula, pelves, &c. were healthy.

Remarks. The preceding is a good illustration of that species of dropsy which is caused by an organic change in the texture of the kidneys, and which Drs. Bright and Christison first made known. We have already stated that the thoracic viscera were sound; and also the liver, which are the organs, to discased states of which dropsy is usually referable; but in the present case, the "origo mali" was in the kidneys, and in the secretory part of these, in consequence