which was recognised as a herniary one, was laid open; a grooved sound was passed upwards, and bloody serum then flowed out; the sac was drawn a little out, and its neck was found to be puckered, and drawn together like a cicatrix. It was divided, and the finger then might be easily carried inwards. The patient quickly recovered. Remarks. In such cases, as the above, are there any signs by which the surgeon can determine, after the reduction of a hernia, whether strangulation continues or not within the abdomen? The abdominal ring should be carefully examined, to ascertain whether it be large and open, whether any pain is felt there, when the finger is firmly pressed upwards and outwards.-Ibid. XIV. ALTHOUGH the utility of the stethoscope is now acknowledged, even by its enemies, yet we fear that many of its advocates are not sufficiently cautious in their diagnoses founded on auscultation. We are less confident now, after more than ten years' study of the stethoscope, than we were at the end of the first two years. Thus, for instance, we sometimes find it extremely difficult, we had almost said impossible, to distinguish nervous palpitation of the heart from hypertrophy of the same organ. Yet the tyro in auscultation will pronounce a decision in half a minute! Case. A young boy, seven or eight years of age, presented himself to Dr. Thwaites, at the South-Eastern Dispensary, complaining of constant oppression at the chest and short cough, greatly increased on using any exertion, and causing suffocation. His health had gradually declined for three years past. He had had rheumatic fever, after which palpitation of the heart came on, with the embarrassment of respiration. "Upon examination, the left side was considered somewhat more distended than the right; the action of the heart was distinctly visible at some distance; countenance anxious, complexion good, but lips approaching to a purple colour; pulse 100. synchronous with the heart's action and regular; pulsation of the carotid arteries greater than natural, tongue clean, bowels rather costive, appetite good, sleeps tolerably well; does not complain of any affection of his head, bruit de soufflet heard distinctly over the whole præcordial region, and on the corresponding position of the vertebræ posteriorly. Fremissement could be felt on the application of the hand to any part of the left side." We need not detail the treatment by venesection, leeches, blisters, colchicum, &c. The Winter interrupted a regular observance of the symptoms; but when the little patient returned, in the succeeding Spring, the disease had evidently progressed. The left side was more bulged out-the blueness of lips increased-pulse 110-great anxiety-bruit de soufflet and fremissement augmented rather than diminished a musical sound very distinctly heard, in three notes, commencing in a grave, and rising in the scale to a sharp thrilling tone. The case was sent to an eminent stethoscopist for opinion, and the following was delivered. "The case is one of narrowing of the left auriculo-ventricular opening, with regurgitation into the left auricle. The signs are bruit de soufflet under the left mamma, which is produced by the passing of the blood through the narrowed opening; and in the same situation very distinct fremissement is felt when the hand is pressed flat against the side. My reason for saying that there is regurgitation, is, that there is very distinct bruit de soufflet heard in the back on applying the Stethoscope over the fourth dorsal vertebra, which I *Dublin Journal, No. V. November, believe is produced by the passage backwards into the left auricle of some portion 1832. of the blood first sent forwards into the ventricle. I should be inclined to say that there is not hypertrophy of the left ventricle, but I cannot be positive, and it is a matter of very minor importance in the case." At this period the hydro-sulphuret of ammonia was prescribed, in doses of four drops thrice a day, gradually increasedand with astonishing benefit, even in a week. "His countenance was quite altered, as the great anxiety which had been so strongly depicted on it was much lessened, and when spoken to he smiled, and said, that he liked to take the medicine, as it made him so much better.' His mother stated that he had not been taking the medicine long ere the oppresion was so much relieved, that he began to talk and play as he was wont to do before he got so bad; and that she came to have the medicine renewed, as he had not got any thing which gave him so much relief. The frequency of his pulse was not in the least relieved, but the violence of the heart's action was most perceptibly so. The bruit de soufflet and the fremissement both continued, but the musical bruit was gone, and could never be heard again. But at this period I left town rather suddenly, and the patient came under Dr. Benson's care. Without having learned from me the treatment I was pursuing, he, for the same reason which induced me, also prescribed the hydro-sulphuret of ammonia in doses of six drops, three times in the day." But all would not do. The essential physical signs diminished not-dropsy took place, and death closed the scene. Dissection. "Upon raising the sternum, the heart presented itself greatly enlarged in its general appearance, and occupying the whole of the left inferior and anterior part of the thorax: the left lung was much compressed and reduced in volume, and the inferior part of the right lung was couaiderably displaced. Upon cutting into their structure, they did not exhibit any appearance of disease. The heart was next removed from its situation for the purpose of obtaining a more accurate examination of its state. The sac of the pericardium was not to be found, the membrane itself having formed so intimate an adhesion to the whole surface of the heart and to the roots of the great vessels, that it could only be separated from them by the practised scalpel of a demonstrator, the adhesion having all the appearance of being of very long standing, except at the posterior and superior part of the left ventricle, where it exhibited appearances of more recent inflammation. When we cut into the right ventricle it was found hypertrophied to once and a half its original thickness, of firm consistence and of a natural colour. Among the cells formed by the carnea columnæ in the walls of the ventricle, were discovered two substances resembling small lumps of fatty substance firmly attached to the lining membrane, and when cut into presenting a small cavity containing a trace of creamylooking fluid on its surface. The cavity of the ventricle was dilated, and the auriculo-ventricular opening was of a size proportioned to the adjoining cavities. The auricle was also proportionally enlarged in every respect. The tricuspid valves, the pulmonary artery and its valves, and also the carneæ columnæ, were perfectly healthy. The left ventricle was considerably thickened in substance, but in no other respect exhibiting an unhealthy appearance. The auriculo-ventricular opening of that side was not diminished in size, but, on the contrary, held a proportion to the rest of the heart. At the insertion of the chorda tendiniæ into the floating edge of the nitral valve, there were firm depositions of a fibro-cartilaginous consistence, which gave to the edge of that membrane a thickened appearance and feel. The "To the best of my recollection these bodies have been noticed before by Dr. Townsend, but where I cannot recal to mind." internal surface of the auricle was partially covered with a firm gelatinous-looking substance, which was internally connected with the lining membrane, so as to present a roughened appearance when scraped with the scalpel. The valves of the aorta were perfectly healthy. At its origin, and for a short distance, the aorta was considerably dilated, bearing an exact proportion to the left ventricle, but rather suddenly assuming its natural size after giving off the great superior arteries. The exact correspondence in the size of all the parts was very remarkable, as well as the absence of those organic changes which we all had so confidently anticipated." The veil being removed, pericarditis was unequivocal. The difficulty of ascertaining this important disease has, many a time, occasioned painful reflections in our mind-for many a time have we been deceived. Several distinguished pathologists, among others, Andral and Louis, have confessed the difficulty. It is our intention to introduce an extended article on this important subject, in the next, or a succeeding number of this journal. The foregoing case meantime, will not be without its use to our readers. XV. CUTANEOUS ERUPTION IN CHOLERA. IN a female who had just recovered from the worst symptoms of cholera, an eruption of lenticular papulæ, of a faint red colour, and surrounded with an areola was observed on the hands and arms. It was at first attributed to the irritation of sinapisms; but as it quickly appeared over all the body, this explanation could not stand; some of the papulæ presented minute pustules on their tops; and here and there they were so dense and small as to look like an erythematous rash. The same appearances were observed in two other cases; and in both of these they were contemporaneous with a decided amendment of the cholera symptoms. Is the eruption a critical one? M. Alibert repeatedly noticed it in many cases under his care. In one case the "measley inflammation extended to the mucous membranes of the mouth, pharynx, nose, and eyes.-Journ. Complem. Sept. 1832. XVI. ST. VITUS' DANCE: TREATMENT IN A YOUNG girl had all the characteristic symptoms of this very curious disease; the twitching of the muscles of the arms hands, legs, and face, the twisting of the mouth, the constant and involuntary shak ing of the head, the unsteadiness of the gait, and of any attempt to lay hold of things, and the embarrassment of the speech, sufficiently announced the disease. The symptoms always ceased during sleep; they had existed for three weeks before Dr. Manners was consulted. She had been twice blistered, and stimulating frictions had been used. The Doctor ordered 15 leeches along the spine; and the spine to be rubbed with a liniment made of the extracts of belladonna, hyosciamus, and opium, dissolved in water. Next day the patient took a tepid-affusion bath; a footbath to be used every night, and the feet to be afterwards enveloped in hot poultices sprinkled with mustard!!— besides these she was to have given her every evening, a "demi-lavement" made of valerian tea; and at bed time she took a spoonful of the following mixture:Distilled water of lettuce, 3iv. Distilled water of orange flowers, 3ii. Concent. water of cherry laurel, gtt. x. Acetate of morphia, gr. 4. The quantity of the cherry-laurel water to be gradually increased. The ordinary drink of the patient to consist of orange. leaf tea. A shower-bath was employed every morning, then this was changed for a douche bath, and the temperature of the water was gradually lowered. The stream was directed on the head and nape of the neck, while the face and chest were protected by a veil !! On leaving the bath the patient was well rubbed with a warm towel, and drank a cup of hot elder tea! In 10 days we are told she was vastly better; in other 20 days she was pronounced to be cured. The patient had taken 22 baths.-Journ. Complem. Sept. 1832. XVII. CANCER OF THE STOMACH FOUND ON LIFE. A MAN, aged 51, entered La Charité on the 5th July, 1832; he was a tailor by trade, and had therefore much sedentary employment. In 1826 he had a very severe attack of jaundice, which lasted for two months, and was treated by emollient and diuretic medicines alone!! [When will many of our French brethren be taught to adopt more active therapeutics? -Ed.] The jaundice returned each year since, but with less severity. Eight months ago, his belly began to swell, and he felt uneasiness in the right hypochondrium; the swelling gradually increased, and when he entered the hospital, the following is the report of his case. The abdomen is enormously distended; the edge of the liver extends down as far as the umbilicus, and may be distinctly felt in the left hypochondrium; the abdominal parietes are hard and tense, and irregularly puffed out here, and depressed there; they are painful on pressure; the limbs are cedematous, the complexion of a pale yellow cast, and, in short, (says our author!) all the pathognomonic symptoms of a cancerous tumour of the liver are present. The patient's strength is exhausted by a constant slow fever, and a diarrhoea. He died in a few days. Dissection. On opening the abdomen the diaphragm was found to be pushed upwards as high as the third ribs; the sharp edge of the liver descended nearly to the christa ilii, and quite concealed the stomach and a large portion of the intestines. The pyloric end of the stomach appeared to be hypertrophied: when cut through, a cancerous fungus was found on Το the mucous coat of it: although the surface of the mass projected four lines at least beyond the rest of the stomach, the pylorus did not seem to have been at all obstructed. We now can understand how this formidable disease may have existed without causing any symptoms during the life of the patient; for the tumour in the epigastrium, which is regarded as the pathognomonic sign of cancer of the stomach, was, in the present case, hid by the enlarged liver; and as the pylorus was free and open, the food was not rejected by vomiting, as is almost always the case. revert for a moment to the state of the liver-its size was truly prodigious, and it weighed 12 pounds, whereas the average weight of a healthy liver is, according to Sommering, between two and five pounds; when cut into, it presented the appearance which has been called "cancer in disseminated masses;" there was a vast number of tubercles, varying in size from that of a pin's head to that of the point of a finger, and either isolated, or connected one with the other; so thickly studded was the liver with them, that not a fifth part of it was of the ordinary parenchymatous texture; when cut into, they were observed to consist of a lardaceous whitish substance, and of a central yellowish substance, which was streaked with red lines; in some places they were hard, in other places soft and encephaloid. Around these masses, the parenchyma of the liver appeared injected, of a yellowish colour, and of a broken-down texture. No cancerous debris was found in the vena cava, nor in the hepatic veins !!—Ibid. Few of our English readers will admit that the preceding is a case of "cancer of the liver." The very description of the author himself must satisfy them of the contrary. We quite regret that the French, who have deserved so well of the medical profession by their pathological researches, should be the least accurate of all authors in their language. It is a question if real scirrhous disease has ever actly the course of the cord, and was of that sickening character which is so cha racteristic of any injury of the seminal apparatus. These particulars removed all doubt from the mind; the patient was bled, leeched and poulticed, and was speedily well."-Annal. de Med. Physiol. June, 1832. been found in the liver; and if we abide by the definition of scirrhus, as it occurs in the breast and uterus, we shall probably be forced to acknowledge, that this morbid change of structure is seldom or never seen in parenchymatous viscera. To satisfy our readers still more of the vagueness and inaccuracy of the French reports, we shall translate the following short passage. The author vauntingly enquires, "in such cases as the above, is a physician to exhibit strong purges and large doses of SINGULAR CASE OF RECOVERY OF THE calomel, as they do in England and in India, where chronic hepatitis, and, consequently, cancer of the liver, are often caused by the abuse of purgative medicines"!! This requires no comment.REV. INFLAMMATION XVIII. OF THE SPERMATIC CORD APT TO BE MISTAKEN FOR INGUINAL HERNIA. THE following remarks, from the Dictionnaire abrégé des Sciences Médicales, are important. "We have repeatedly witnessed cases, in which the surgeon has been puzzled to form a correct diagnosis. When a painful swelling in the groin follows a fall, or any violent effort, rupture is immediately supposed to have taken place; but perhaps quite another accident may have occurred. The following is a case in point. A man fell from a considerable height, and on recovering himself, he felt severe pain in the inguinal canal, and the pain extended to the loins; vomiting came on, and a feeling of general distress and anxiety; the abdomen was drawn in, and was very painful on pressure; the pulse was small and wiry; and, upon examining the groin, an oblong, hard, and painful tumour extended from the inguinal canal towards the testicle: it might have been mistaken for hernia, but it was observed that it was identified with, and formed, as it were, a part of, the spermatic cord, and, moreover, that it did not terminate inferiorly, as a rupture does; that the pain followed ex XIX. MOTIONS OF A STIFF KNEE-JOINT AN old artillery-man was much exposed In the month of February of the present year he caught a severe catarrh, which was accompanied with high fever; pow. erful sudorifics were given, and a very free perspiration was thereby produced. As symptoms of typhus came on, he was well vomited and purged. During the efforts of vomiting, he felt severe pains in all the joints, and a sensation of cracking in his bones, to use his own words. In a day or two after, he lost the use of his right arm, and considerable gastric distress came on; but it was quickly relieved by enemata, which brought away immense |