ble and inconsiderable it may be, and, with the aid of this instrument, have been able to give more precision to any enquiries on the development and influence of electricity upon chemical actions. And, lastly, Siebeck has shewn, that an electrical current may be produced in metals, without the intervention of any liquid, and merely by the action of caloric. By thus establishing the identity of magnetism and electricity, these authors have made a great stride to the knowledge of nature's laws; and when we reflect that there is a strong presumption that electricity, caloric and light are but one agent, or power, variously modified, and that there is a closer connexion between the phenomena of electricity and those of chemical affinity and of general attraction, we have reason to think that we are on the eve of some of the grandest and most important physical discoveries.- Ibid. X. INVERSIO VESICE.' THE following case is published in the first number of a contemporary periodical, to which we bid hearty welcome, and wish every success-the Liverpool Medical Gazette. The author is Dr. P. J. Murphy. "Jane R―y, æt. 4, admitted into the county of Meath Infirmary, July 9, 1829. Her mother stated that she had been seen by a medical gentlemen six hours previously, who had represented the disease under which she was suffering to be prolapsus ani, but failed in reducing it, after a tedious trial. On learning that mortification would most probably be the consequence of its non-reduction, she became alarmed, and brought the child to Mr. Nicolls of Kavan, who, having satisfied himself that it was some unusual disease, immediately brought her to the infirmary, where she was seen by Dr. Byron, the present surgeon to the Infirmary. For examination she stood on a table, with her face towards the examiners, and our first impression certainly was that of it being a case of prolapsus recti. We prepared to reduce it in the usual manner, by men. placing her on the back, elevating the head, and fixing the thighs on the abdoCatheters were also in readiness to empty the bladder. Immediately after having thus arranged the patient, the anus and perineum were plainly discernible. A closer examination now became necessary, and the following appearances were noted down. A pyriform tumour, the size of a small hen-egg, depends from between the upper portion of the labia-pudendi, colour of a dark mahogany, the base below, the apex above; the little finger oiled and introduced per anum, communicates no motion to the tumour, nor can any thing unnatural be detected. On raising the tumour towards the pubis, the vagina was seen, but the meatus urinarious could not be traced. Some congenital deformity was now suspected, but the mother's answers which were very clear, satisfied us on that point. We now sought to ascertain if the bladder were inverted. The orifices of the ureters were looked for, but not discovered until a very slight traction of the tumour downwards rendered the inversion complete. A small silver probe was passed up each orifice, which, on being withdrawn, was followed by urine, almost devoid of either smell or colour. REPLACEMENT-The neck of the bladder was steadied by the thumb and forefinger of the left-hand, and the fundus having been pushed upwards by the end of a gum elastic catheter, its re-inversion was easily effected. The catheter was retained there for a few hours by an assistant. Some tenderness of the public region following, attended with vomiting, leeches, warm-bath, and castor oil were prescribed, to which those symptoms quickly yielded. On the 17th of July she was discharged cured. able to consult the Cas Rares.' It is true that Mason Good says something about prolapsus vesicæ into the urinary passages, under two forms. He quotes from Sauvages. First form, a protrusion of the inner membrane, in consequence of its separating from the general substance of the bladder, visible in the meatus, urinarius, of the size of a hen's egg, subdiaphanous and filled with urine. Sauvages' case is quoted from Noel, who met with it in a virgin, who was, from the first, peculiarly troubled with retention of urine, accompanied with frequent convulsive movements. The state of the tunic was proved by dissection. But this case is no ways analogous to the one I have just related. I am inclined to consider it a case of congenital malformation from the word first, which signifies in the above case, from birth, or perhaps it was anasarca of the submucous tissue from inflammation. It is stated to have been filled with urine, but, if separated from the general substance of the bladder, how could it be filled with urine unless from some opening by ulcer, or otherwise? Mortification must have been the consequence of such effusion. The second form, he tells us, is chiefly found among women who have borne many children. The protruding cyst drops down into the urinary passage to about the length of the little finger, and is sufficiently conspicuous between the labia.* He gives a case from Solingen. Where the anterior wall of the vagina has been destroyed, and a communication formed with the bladder, an inverted bladder is by no means uncommon. I do not remember any cases of inversion where the destruction was confined to the urethra alone. Anatomically considered, inversion is more likely to take place in the "Dr. Good seems rather to describe prolapsus vesica than inversio, but as he places both inversio and prolapsus uteri under the genus "Edoptosis," there is some difficulty in understanding exactly what disease he intended to describe." young than in the aged. In the child, the shape of the bladder, both in its distended and contracted state, is pyriform, the base above, the apex below; while its axis is almost perpendicular; in the adult, its form, when distended, is oval; when contracted, a flattened triangle, its long axis oblique, anteriorly pointing to the linea alba midway between the pubis and umbilicus, posteriorly if produced will touch the extremity of the coccyx. In consequence of the non-development of the pelvis of the child, the bladder is almost en tirely in the hypogastric region, subject to the action of all the abdominal muscles, particularly that of the pyramidales and the lower divisions of the recti, from which it is separated only by a thin fascia. In the adult it lies altogether in the pelvic region, unless when distended, and, as it is only in the contracted state that inversion can take place, it is almost entirely withdrawn from the influence of the abovementioned muscles; moreover, in the child the ligaments of the bladder are weak and yielding, the urethra absolutely shorter, and there is scarcely any angle formed between the bladder and urethra, which must favour inversion as much at this period of life, as the contrary form tends to prevent it at a more advanced time. Inversio vesicæ is not analogous to the inversion of any other part of the human body. It resembles that of the uterus more than that of any other organ. But the cause of the latter being inverted is easily understood, namely, a foreible separation of the placenta, polypus, &c.; and, did the same causes exist in the bladder, no doubt we should have inversion very common; but in the case I have just related the surface was minutely examined for either polypsus or an adhering calculus, but its healthy appearance was sufficient testimony that none of those causes existed. The inversio uteri in the unimpregnated state, has been denied by some, and, no doubt, if in this state it had not been subject to polypus, the opinion would have been correct; but I have seen a polypus completely invert the uterus. although unimpregnated, and Dr. Byron mentioned to me another which occurred in his private practice. Could the inversion have taken place in the following manner? In its contracted state the internal surface of the fundus might have easily fallen down on the opening of the urethra, so as to form something like a partial inversion. In this case its serous surface would have formed a funnel, the concavity looking upwards, if a portion of intestine filled this cavity, a sudden exertion of the abdominal muscles might have completed the inversion." XI. ON THE VARIOUS SORTS OF PERMANENT 1. THE first that we shall mention, is that 2. A permanent flexion of one or more fingers may be the result of some disease or malformation of their joints. Case. A young man had white-swelling of the ankle-joint. The little finger of the left hand had been permanently contracted in the form of an arch, from his infancy; the phalanges did not move, the one upon the other; but there was free motion between the finger and the metacarpal bone. No hard cord or projection was felt in the palm at the root of the little finger, when this was forcibly bent backwards, or extended. In short, the permanent flexion in this case arose from an anchylosis of the phalanges. In some cases it is produced by a synovial cyst forming over one of the joints; this mishap is not very unfrequent among tailors; in others by an irregularity, or unevenness, of the articular surfaces of the phalanges. We observe such cases among tailors, seamstresses,and especially among knitters. In them a contraction of the little finger is not uncommon, and it proceeds from some abnormal change in one or other of the joints. Case. A young female, who worked in the manufactory of lace, applied to Dupuytren, to relieve her of a contraction of the four fingers of both hands upon the palms; they were bent so as to form nearly a quadrant of a circle. The phalango-metacarpal joints were quite free; when the first phalanx was strongly bent backwards, no tense tendon or cord was to be felt. 3. A third variety of the affection is, when it is caused by a division of the tendons of the extensor muscles. A person applied to Dupuytren under the following circumstances. The two last fingers were constantly bent upon the palm of the hand; yet on extension, they could be readily made even with the others; but no sooner was the extension withdrawn, than the While exfingers again became bent. tended, no hard cord was to be felt on the palmar, or on the palmar surface of the finger; and moreover, each joint might be easily moved. The patient had received a sabre cut on the back of the hand, and the tendons of the extensors had been divided. Nothing could be done for him. 4. A puckered cicatrix of the skin will sometimes cause flexion of the corresponding finger or fingers; hence the importance of keeping the hand extended during the healing of any wound, sore or burn. 5. A lesion, or injury of the tendons of the flexors may have the same effect. This variety is apt to be confounded with, and mistaken for the first, or that which results from a contraction of the palmar aponeurosis: but in the latter case the finger cannot be made to yield to any extension, and the tense cord, which was not to be felt before, is now readily recognized during the effort. When, on the contrary, the malady has been caused by an injury of the tendons, the projection, which was very distinct while the finger is bent, becomes much less so, or altogether disappears when it is forcibly stretched. example of this variety is detailed: a tu An mour had been exercised from the finger, and during the operation the sheath of the tendon had been opened. 6. This last species of permanent flexion of the fingers is that which arises from the loss or wasting of the substance of the flexor muscles. This may be destroyed by a gun-shot wound of the fore-arm, or by laceration, from any violence. In such cases there is always more or less paralysis, in consequence of the injury done to some of the nerves. The different joints of the fingers remain quite flexible; but when they are forcibly extended, pain is felt at the cicatrix of the wound. It must be altogether unnecessary to state that these different varieties of the above malady require different modes of treatment, according to the nature of the exciting cause.-Journ. Comp. Sept. 1822. XII. CASES OF DIFFUSED INFLAMMATION AFTER BLEEDING IN THE FOOT. Case 1. A young woman was ordered to be bled in the foot, at the Hôtel Dieu, in consequence of amenorrhoea. The operator made several attempts to open a vein at the external ankle, but failed; the saphena vein was afterwards opened. In a few days appearances of spreading inflammation of the skin and cellular substance shewed themselves, and afterwards great tumefaction, pain, and general disturbance. Leeches and poultices were applied; but the disease became worse and worse, and the patient was delirious, and suffered much from vomiting, purging, and extreme sensibility of the abdomen. She was brought into the surgical wards on the 20th day from the commencement of the symptoms. Bleeding from the arm was immediately ordered, and two long incisions were made along the foot; much fetid and sanious matter flowed out; and a third incision was made at the upper and inner part of the leg, where a large purulent collection had formed. Thirty leeches were applied to the epigastrium. Gangrene of the back of the foot came on; and an intense inflam mation had invaded the upper part of the thigh. Forty leeches were immediately applied to the part. A long incision was made on the outer side of the thigh. It was not till the end of the sixth week that the inflammation of the limb had entirely ceased; the tendons of the extensors of the toes sloughed off. In two weeks more most of the incisions had healed, and the large exposed surface of the foot was healthily granulating. In six weeks more she was able to leave the hospital, but the limb as yet was little able to execute any movements. Case 2. A woman chanced to prick her finger with a thorn; inflammation of the arm speedily came on, and also symptoms of extreme gastro-enteritic irritation. When she was brought to the hospital, three weeks after the accident, she could give no account of herself; the whole limb was enormously swollen, and all the signs of a very aggravated typhus were present. She was immediately bled, and the part leeched and poulticed. Five days after this date, she began to complain of pain in the knee: when it was examined, a distinct fluctuation could be felt; free incisions were made at several parts; but as the inflammation abated in the arm, it increased in the leg, and all the disturbance of head and abdomen was renewed; she died on the ninth day ofter entering the hospital. Remarks. The very formidable disease, which is illustrated by the two preceding cases, sometimes attacks the head, and is then not unfrequently fatal. It is of importance to observe that when the cellular tissue between the pericranium and the occipito-frontalis aponeurosis is the seat of the disease, and when it has gone on to suppuration, so as to detatch the integuments from the subjacent parts, these integuments are not so liable to fall into a state of sloughing as the integuments of the extremities, and of other parts; and why is this? Because the blood-vessels, namely, the branches of the frontal, temporal, and occipital arteries are so very intimately connected with the skin of the head; whereas in the arm and leg, &c. the nutritious arteries of the skin are mostly small vessels which pass to it from the subjacent textures, and through the subcutaneous cellular substance; hence, when this web is destroyed by suppuration, the permeating arteries and veins are no doubt involved at the same time: in the case of the scalp it is otherwise; for its vessels directly appertain to it, and not to the pericranium and bone. It is of much consequence to ascertain whether the pus has not injured the pericranium; for when this membrane is destroyed, recovery is very rare; and when it is not we may very generally entertain better hopes. Even in the worst cases, the scalp seldom becomes lifeless or sloughs: and for the reason of the peculiar arrangement of the blood-vessels above-mentioned. M. Dupuytren has seen in his vast practice only two cases of actual gangrene of the scalp. -Ibid. XIII. Two CASES OF HERNIA, IN WHICH THE OPERATION WAS PERFORMED, ALTHOUGH THERE WERE NO EXTERNAL SWELLINGS. A MAN, aged 40, had an inguinal rupture on each side; the one of 12 years, the other of three years standing. After a violent effort, the former, or that on the left side became suddenly enlarged and very painful: it was after some time reduced, but the symptoms of strangulation continued, and on the 5th day he was carried to the Hôtel Dieu. The abdomen was very tender, and he suffered much from hiccup, fæcal vomiting, and pains of the bowels; there was no outward appearance of any herniary tumour; the abdominal ring when examined, were found more open than usual; there was a fulness in the right groin on the following day, and when the part was pressed, it was very painful. Dupuytren cut down cautiously to ascertain the state of things; he opened a small smooth-lined sac, from which a good deal of serum issued; but there was no trace of gut, or of omentum : when the finger was passed up into the abdomen, several adhesions could be distinctly felt. Dupuytren immediately operated upon the other side; the second incision opened a small sac, which contained a fatty mass, mistaken at first for omentum ; but by making the patient cough, a layer was observed beneath it, and when this layer was divided, much bloody serum flowed out. Dupuytren, was now satisfied that the strangulation existed upon this side, in consequence of the difference of the serum from that which was noticed on the other side. In the sac a small portion of inflamed omentum was found, and on introducing the finger up the ring, a circular bridle could be felt; the sac was gently pulled outwards, and along with it a small portion of gut; a probe bistoury was cautiously introduced, and this bridle was divided upwards and outwards. The patient ultimately recovered. Case 2. A man was brought to the Hôtel Dieu in an apparently dying state; he was hiccuping, vomiting, with cold extremities and tumid painful belly. It was with difficulty that he could tell that he had long suffered from a double rupture; but there was no outward sign of any swelling. The question was, whether the case was one of peritonitis, or of concealed hernia. Dupuytren ordered the patient to be bled, and to have repeated enemata given. Several copious alvine evacuations were procured, the vomiting ceased, but the hiccup continued. On the following day he was considerably easier and more collected, so as to be able to give some account of the progress of his malady. He had laboured under a rupture on each side for eleven years, they had never much incommoded him till the day before he entered the hospital; but suddenly after an exertion they became painful and irreducible for some time; both however were speedily returned by the taxis; yet most of the symptoms of strangulation continued. An incision was made over the right inguinal ring, and a smooth sac, |