four ozs. of brown sugar in four ozs. of water were injected, and the œsophagus tied. The animal remained quiet for 20 minutes; it then struggled to vomit-passed two stools, which were of a blue colour, but did not utter any cry; two hours after the operation, it lay extended, and made no efforts to vomit, and in another hour it died. Exper. 2.-The same steps were followed as in the preceding case, only, instead of the sugar, the whites of four eggs, blended with water, were introduced after the copper; the dog died in five hours after the operation. The conclusions which M. Postel draws from all his observations are 1. That sugar decomposes the acetate of copper, not only at the boiling temperature, but at the ordinary one of the atmosphere, although more slowly-that this decomposition proceeds more or less rapidly, according to the concentration of the fluids; and that, under all circumstances, the coppery salt is reduced to a protoxide. 2. That sugar exerts an analogous effect in the stomach, since animals to which it is administered, resist the agency of the poison much longer than when it is not; and since the morbid appearances on dissection differ considerably in the two cases. 3. The morbid appearances, when albumen has been given, are nearly the same as when sugar has been given. 4. Sugar may, therefore, be considered among the direct antidotes against poisoning from salts of copper.-Ibid. LXIII. VISIT OF M. CLOT BEY TO THE HÔPITAL PHANTIASIS. 'THIS distinguished physician of the Pacha of Egypt, and founder of the medical college at Abouzabel, near Grand Cairo, recently visited the wards of this large hospital, where more cases of skin diseases are to be VOL. XVIII. No. 36. seen than in any other. The Baron Alibert, one of the physicians, accompanied M. Clot. Among the cases was one of elephantiasis of the lower extremities, an affection very common, and indeed endemic, in Egypt. The treatment found most effectual, in that country, is compression with straps of diachylon plaster. The whole limb is enveloped with the straps, which are to be neatly applied, the one overlapping the other, and made to cross on the fore part. The effect of this treatment is to cause a more or less copious exudation from the diseased surface. The straps are to be kept on for a considerable time, and removed when necessary; in removing them, we should divide them across with scissors the whole length of the limb-then the whole may be taken off, like a long gaiter, at once.-Révue Med. LXIV. THE VARIOLOUS EPIDEMIC AT TURIN, IN 1829. M. GRIVA, an eminent physician at Turin, has published an interesting memoir on this epidemic. He is a strong advocate for vaccination, and states it as his opinion, that upwards of 4000 inhabitants were saved by its means; that it is a better safeguard against small-pox, than even one attack of small-pox is against another; and that the disease, modified by vaccination, is milder than modified by a previous attack of the variola itself. He points out, with great exactness, numerous forms of variolous and vaccine papules, and also of other eruptions which are apt to be mistaken for these, and urges the necessity of carefully attending to the discrimination of these. He has made numerous experiments on the comparative efficacy of the virus, taken directly from the cow, and of that which is obtained from the arm of a person who has been vaccinated; and draws the conclusion, that its properties are not changed, nor modified, by passing through the human body. He says that vaccination is to be regarded not only as the best prophylactic of variola, but also as a curative means in many other diseases, 46 above the middle of the left supra-orbital ridge, there was a lacerated wound, through which a portion of the frontal bone, about an inch in diameter, was observed to be fractured, and slightly depressed. He was immediately bled to twenty-four ounces; and on visiting him at nine, P.M., about three hours after his admission, Dr. M. found that his pulse had risen to eighty, and that he had a slight rigor. The depressed bone was firmly fixed, but at one point the pulsatory motion of the fluid blood, which filled up the fissure, showed that the fracture extended through both tables of the scull. On enlarging the wound by a crucial incision, and dissecting back the flaps, Dr. M. raised up the depressed bone with the clevator, and removed it in five separate pieces, along with a small coagulum. From the oozing of blood, the small size of the opening in the cranium, and the restless state of the patient, who was secured with some difficulty, it was impossible to ascertain whether the dura mater was injured or not. The edges of the wound were retained in contact by a suture, and the usual dressings, with a double-headed roller, applied. A bladder containing a refrigerative mixture was applied to the head, and a purgative exhibited. For the first nine days, the most active antiphlogistic measures were employed. Besides smart purging, nauseating doses of emetic tartar, &c., one hundred and twelve ounces of blood were detracted by venesection. On the 14th, an abscess burst in the left ear, after which no unfavourable symptoms occurred. The wound healed slowly, the pulsations of the brain became gradually more obscure, and he was dismissed, cured, on the 19th of March. "In such a case," says Dr. M. "nearly all the surgical authorities of the present day condemn the practice of applying the trephine, and removing a sound portion of the cranium, that the depression may be elevated, unless symptoms of compressed brain exist. They approve of the removal of such loose and detached splinters as can be readily laid hold of by the foreceps, or raised by the elevator: but until symptoms of compression appear, either from the effu. sion of blood, or the occurrence of suppuration, they are, with one or two exceptions, unanimous in condemning the trephine. On the contrary, Pott recommends that the cranium be perforated, and the depressed bone elevated, not with the view of remov. ing existing symptoms, but as a preventive of ill consequences. Sir A. Cooper, and Mr. Brodie, appear less hostilely opposed to this practice, than the rest of their contemporaries. The former gentleman says, 'I generally use an elevator to raise the depressed bone, but rarely apply the trephine;' whilst Mr. Brodie is of opinion, that, when the depression is slight, and the symptoms trifling, the trephine should be applied only when the injured bone is exposed, in consequence of a wound in the scalp. Considerable diversity of opinion also exists as to the cause of the suppuration, which so frequently occurs in the neighbourhood of a fractured and partially-depressed bone. The majority assert that this suppuration does not arise from the depressed bone, but from the violence inflicted on the brain by the original injury; and that, of course, the application of the trephine cannot prevent the formation of the pus, but, on the contrary, by the additional injury which it produces, the inflammatory mischief will be greatly aggravated: they have recourse, therefore, to active antiphlogistic treatment, which they maintain is generally successful in warding off the impending danger; and assert that the trephine ought not to be ap plied, till, from the accumulation of matter, unequivocal symptoms of compressed brain manifest themselves. To wait for this occurrence, is to delay till the chances of success from surgical interference are almost hopeless. We have no means of ascertaining the exact situation of the purulent collection, or whether it lies above or below the dura mater; and we shall often fail in evacuating it, even after the trephine has been employed. I have seen it spread over an entire hemisphere; and when it is se situated, and so extensive, the disorganization of the brain, resulting from its accumulation and diffusion, will frequently lead to a fatal result, even although it should be evacuated by an operation: but this cannot be accomplished when it is collected under the pia mater, a situation in which Sir Astley Cooper states that it will be ge charge appeared, and has continued reguLarly to the present time, a period of 18 months.-Ibid. LXX. SHORT-WINDEDNESS IN THE HORSE. THIS affection is generally dependant upon pulmonary emphysema, either of the vesicular or the interlobular kind. The French veterinary surgeons employ the stethoscope with great advantage in their practice; the feebleness of the respiratory murmur, the friction sound, the crepitant and sibilant râles, along with strong resonance of the chest on percussion, are the diagnostic marks of pulmonary emphysema in the horse, as in man. According as these signs are heard over a great or small extent, so is the disease to be considered general or local. LXXI. INSANITY IN FRANCE. THE number of the females exceeds that of the males, in almost all the lunatic houses throughout France. Between the 30th and 50th year, the influence of age appears to be nearly the same on both sexes; but rnany more men than women become deranged before the 30th year, and the reverse holds good after the 50th year. Not many cases of insanity occur in young persons under 15, nor among the aged after 60, except of that form which some have termed "dementia senilis." As to the influence of marriage on the frequency of insanity, it is observed that nearly twice the number of cases occur in bachelors as in married men, and more than twice the number in single than in married women. If the cases of insanity are grouped according to the threefold division of mania, monomania, and dementia, we find that more than one-half the number belong to the first class, about a fifth of the number to the second, and only a tenth to the third class, viz. that of idiotcy. Mania often succeeds to monomania, and both these states not unfrequently pass into dementia. It is much more rare to observe the idiot become maniacal, either generally or upon one subject. The most common pathological appearance observed upon dissection, is effusion of a sero-lactescent fluid between the arachnoid and pia mater; sometimes wasting or degeneration, at other times increase in the bulk, of some of the cerebral convolutions is distinctly marked; and in several cases, the morbid alterations have been found well to accord with the phrenological positions of the organs. It is right, however, to remember that, very frequently, not an appreciable trace of disease is found on examination of the brains of insane persons.-Annal. d'Hygiene, &c. LXXII. FRACTURES OF BONES BY THE ACTION OF THE MUSCLES. A YOUNG man, aged 23, while amusing himself by throwing pebbles to a distance suddenly felt a snap and severe pain at the lower third of the arm; all the signs of fracture were most apparent; yet he had received no blow, nor had he fallen. The arm was put into splints soon after the accident. Seven months subsequently he entered the Hôtel Dieu; the fracture had never united. The patient was under treatment at the date of the report. Remarks by Dupuytren on the preceding Case. The bones most commonly fractured by mere muscular force are the patella, os calcis, and the olecranon of the ulna. Dupuytren has seen upwards of 20 cases of fractured patella; and the mode in which the accident generally happens is this-a person with a heavy load on his back stumbles forwards; he attempts to recover his equilibrium, and, during the effort, the violent action of the extensors of the knee causes the patella to snap. He has seen the olecranon broken in a young man playing at tennis, while aiming to strike the ball. When the long bones break spontaneously, the cause is, in the majority of cases, to air and vigour, are probably the most essential protectors against contamination; but whether differences in the maternal discharge are operative in rendering the infant more or less liable, is a question that we cannot pretend to solve. It certainly does appear, that a person with gleet may or may not communicate gonorrhoa to the female with whom he is connected, and it is also likely that what is termed leucorrhoea, that is a mucous discharge from the vagina, not consequent on venereal infection, will occasionally, but not commonly, infect the male. We are not well acquainted with the laws that regulate the infecting power of vaginal discharges. But let us pass to Mr. Middlemore's method of treatment. It is rather judicious than novel. In slight cases, an astringent lotion and a dose or two of magnesia will effect a cure. The majority of cases are not so slight, and much depends on obtaining the management of them at an early period. In such a case, at such a period, we may use a solution of alum and a slight aperient. The eye should be washed every half hour, or, if necessary, oftener, with a well made ivory or pewter syringe, the point not too sharp; the extremity is to be placed between the lids, at the outer angle of the eye, and should pass it, for a short distance, almost parallel with the surface of that organ, and not so obliquely as to hurt the eye-ball, or oppose the conjunctiva as an obstruction to the issue of the fluid. The eye is thus to be syringed with a little warm milk and water, after which a weak solution of the sulphate of zine or alum (gr. iij. ad 3j.) may be thrown in, and repeated, with the same preliminary washing, every second hour. Mr. M. recommends the nurse to apply a little fresh butter, or sweet oil, or mild ointment, along the tarsal margins, whenever the child is about to sleep, a precaution which renders unnecessary the tedious bathing the lids. This should be combined with a dose of magnesia, or, if the child be jaundiced, as sometimes happens, of hydrargyrus cum cretâ. The inflammation may be severe, with chemosis, &c. Mr. M. then recommends the application of a leech to the root of the nose, or upper lid of each eye, according to circumstances. Of course great care must be taken to prevent the bleeding from proving too considerable. If the lids are much swollen, with obstructed circulation, and if any vessel be particularly large, it may be opened with a lancet, and the bleeding encouraged by warm water. If the case has proceeded farther, the cornea having ulcerated or sloughed, the chemosis diminished, and the conjunctiva become comparatively pale," it would be right to use a solution of the nitrate of silver (two or more grains to the ounce) two or three times a day, the eyes being frequently bathed with zinc lotion. If suppuration of the eye-ball has taken place, the surgeon should not be too tardy in puncturing the cornea, and discharging the contents of the eye-ball. Mr. Middlemore protests against "the harsh applications" of Dr. Vetch, particularly the undiluted liquor plumbi acetatis. He also thinks that, at the present time, there is an "extraordinary partiality for the early employment of stimulants." He would not wish them used till the proper time, that is, till the acute stage has passed by. Mr. Middlemore cannot coincide with Mr. Guthrie, in using the unguentum argenti nitratis in the earliest stage of the purulent ophthalmia of infants. As Mr. Middlemore's strictures are levelled against stimulating applications generally, when employed in the early stages of ophthalmia, we may be permitted to make this remark-that at Mr. Guthrie's Ophthalmic Hospital, stimulants are not found to be productive of those mischiefs which their opponents attribute to their employment. For the results of Mr. Guthrie's treatment, we can safely refer to a report from the Ophthalmic Hospital, published in a late number of this Journal. The cases there detailed are satisfactory evidence of the advantages, we put it broadly, the great advantages, of stimulating early in certain conjunctival inflammations. tion on the skin does not in itself constitute the exanthematous disease; that the eruption is merely one of the elements or phenomena of it, and that without denying the existence of other simultaneous complications, such as changes of the blood, direct affections of the nervous system, &c. by far the most common and most important is an inflammatory congestion of the encephalic, respiratory, or digestive organs. Now it is proper to observe that the internal phlegmasia, which so very frequently accompany eruptive fevers, assume sometimes a special or particular character; thus, the angina in scarlet fever is ordinarily of the diptheritic kind; but yet it would be a most serious error, if we supposed, with some able physicians, that these specialities forbid the employment of anti-inflammatory remedies. In the 13th bed of the ward, St. Jean de Dieu, you saw a young man in whom scarlatina was accompanied by an intense diptheritic angina, extreme exhaustion, intermittent pulse, and great dryness of the skin; the prognosis was certainly, to all appearance, most unfavourable. He was bled, and had leeches applied several times to the throat, and all the worst symptoms speedily vanished. Certainly we are not to overlook the various forms which inflammations may assume; but we must be always careful not to lose sight of the very foundation of the disease; the old adage is generally a true one-"la forme emporte le fond." In the disease which has been called typhus, or typhoid fever, entero-mesenteric fever, dothinenteritis exanthema intestinalis, and which we have designated entero-mesenteritis, because, in reality, the inflammation of the small intestines and of the adjoining mesenteric glands is the fundamental element and starting-point of the disease, the antiphlogistic treatment has been uniformly and most successfully adopted. We have very seldom employed the chlorurets at the same time; these remedies, however, form excellent adjuvants, in many cases of those fevers which are termed "essential." They were first recommended in the treatise which I published in 1826. In "erysipelas," the treatment has con sisted in bleeding, when the disease was severe, and in the exhibition of ipecacuan and the employment of the antiphlogistic regimen when it was mild. The progress of "tubercular bronchilis” was very sensibly arrested, in many instances, by means of a low diet and the occasional application of a few leeches, of the cupping-glasses, and of revulsives. There was one case of partial phthisis (a cavern at the summit of the right lung), which was completely cured in this manner. "Partial Dropsy." Many examples of this affection have been witnessed by our students; they have been almost all traced to some impediment to the venous circulation, arising from obliteration of the vessels by fibrous concretions in their cavities. Professor Chomel (Lancette Française, No. 81) mentions a case, in which the adema was confined to the upper half of the body; see, also, a paper on the Obliteration of the Veins, and its Influence in producing Partial Passive Dropsies," in the Archives Générales de Médécine, 1824. Several cases of diseased heart, of peripneumony, of effusion into the chest after pleuritis, of hæmoptysis, of typhus fever, of colica pictonum, of jaundice, are detailed; the same general therapeutic means were employed, namely, bleeding, general or local, varying in quantity according to the symptoms, and the other parts of the antiphlogistic regimen, with very striking advantage. 'Tis most gratifying that the indications of cure, in very many diseases, are now so simple and well understood, and that the practice of medicine is becoming every day less and less empirical, and acquiring a more rational and satisfactory character. This change of things we owe to the great mind of M. Broussais, the father of reformed medicine. M. Bouillaud has used the antiphlogistic treatment in cholera with certainly as great success as can be fairly claimed for any other method proposed. In 34 cases, lately under his care, only 9 died, although 14 were in the last stage of the disease. Numerous cutaneous diseases have been cured, nay, we might rather say strangled, by the repeated |