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patches of discolouration. On dividing its parietes, a large quantity of blood flowed out. It was long before we could find out whence it had proceeded. At length it was discovered that there was a rent-large enough to admit the point of the finger-in the inferior cava, on the level of the last dorsal vertebra: its edges were irregular and fringe-like. All the viscera were quite healthy.

It follows from the pathological appearances in this case discovered on dissection, 1st, that the death must have been rapid; and 2nd, that the perforation of the vena cava was probably consecutive upon an atrophy of the parietes of this blood-vessel.

The opinion of M. Vidal (de Cassis) on this subject is thus expressed in his "Traité de Pathologie Chirurgicale et de Medecine Operatoire" :-" Atrophy, when extending to each of the membranes which compose a blood-vessel, or even affecting but one of them, necessarily weakens it, and sometimes reduces the vascular parietes to an extreme tenuity. Hence arises the fear of these ruptures, which have been observed in the superior cava, the vena portæ, &c. These ruptures are either with or without some appreciable morbid lesion."

M. Andral, in his "Precis d'Anatomie Pathologique," cites a case in which, in the middle of a scuffle, a man in good health fell down suddenly, and expired in a few seconds. On opening the body, there was found a perforation of the abdominal vena cava. The edges of this perforation seemed as if they had been torn; but around it, the vessel appeared in a perfectly healthy state.-Annales de la Chirurgie.

TREATMENT OF BED-Sores.

A writer, in a recent number of Walther and Ammon's Journal, recommends the application of a lotion composed of equal parts of spirits of Camphor and the vegeto-mineral water of Goulard. The parts, that have become red by the pressure, should be repeatedly moistened with this lotion; it requires to be briskly shaken before it is applied.

If, in spite of this treatment, the skin should break, the zinc or lead ointment, to which some camphor has been added, is a good application. In still more obstinate cases, an ointment, consisting of four parts of fresh-prepared Tannate of Lead, and thirty of lard, has been sometimes found to answer extremely well. On the whole, however, nothing succeeds so uniformly, alike as a prophylactic remedy against the abrasion of the skin and a healing one to that which has become broken, as a solution of Creosote-prepared after the method of Reichenbach-in the proportion of one part of the oil to 80 parts of water.

When the affected part becomes gangrenous, fomentations with a decoction of Yellow Bark, to which some tincture of Myrrh has been added, may be useful. Some patients have found benefit from the sprinkling of the ulcerated surface with a powder composed of Bark, Camphor, and Myrrh; others, from the use of the Camphorated styrax ointment. The tinct. Benzoini compos., or Friar's Balsam, is often an excellent application to bed-sores. Whatever be the nature of the application employed, the most important remedy of all is the removal of pressure from the affected parts, by means of air or water cushions. The comfort derived from the use of these is most pleasing.

EXCISION OF THE ENTIRE SCAPULA WITH A PORTION OF THE

CLAVICLE.

An old soldier, who had served in the Imperial Guard during the campaigns of

1813, 1814, and 1815, had been for several years distressed with uneasiness and pain in the upper part of his left arm. In the course of time, a hard tumor formed there; being attached, it was thought, to the humerus: it was extirpated; and the wound healed kindly. Six months afterwards it was deemed necessary to amputate the limb at the shoulder-joint, in consequence of the cervix of the bone having become decidedly diseased. The round head of the humerus, as well as the surface of the glenoid cavity, was at this time most attentively examined and pronounced to be entirely free from any morbid alteration. This operation also succeeded perfectly. Little more however than half a year after its performance, the patient began to experience pains in the cicatrix, and ere long a new tumor formed in the site of the axilla. As this increased in size, the pains became more severe it had already attained the bulk of the closed fist, when the case again came under the observation of Professor Rigaud of Strasbourg. The swelling was evidently of an osseous nature, and seemed to be attached to the cervix of the scapula; it was free from any adherence to the parietes of the chest, following all the movements of the shoulder: the clavicle seemed to be quite intact. After a tedious dissection the entire scapula, having the tumor affixed to it, was extirpated, the clavicle having been first cut across with a chain-saw passed under it. The cure was complete in the course of two mouths.-Comptes rendus de l'Academie.

HÆMORRHAGE AFTER LITHOTOMY, CHECKED BY CREOsote.

During the performance of this operation on a boy 14 years of age, it was remarked that, when the skin and perineal muscles were divided, there was a more profuse discharge of blood from the wound than usual. After the calculus had been extracted, the hæmorrhage nearly ceased for a couple of hours; but then it returned as profusely as ever. From its character, M. Daser suspected that the blood proceeded rather from a multitude of minute vessels than from any single one of considerable size. Several small arteries had been tied during the operation; and cold applications and absolute repose were now enjoined. These failing, the wound was plugged up with a piece of sponge; but, after a few hours interval, the blood having accumulated within the bladder, violent expulsive efforts came on and forced the sponge and a large quantity of coagula out. A canula was then introduced by the wound and retained in the bladder, and the sponge was replaced; still the bleeding continued. As the patient had now become very pale and faint, M. Daser had recourse to the local use of creosote. He dipped a sponge in the pure oil, and inserted it deep into the wound, having previously secured a piece of tape to it, so that it could be easily withdrawn at any time. For a few minutes the pain induced by the application was very sharp, but then it subsided altogether. The edges of the wound assumed a blackish-grey colour, and the hæmorrhage ceased. At the end of ten minutes, expulsive efforts ensued, and the sponge, along with a quantity of coagula, was expelled. A fresh sponge was introduced; and no further discharge of blood took place. M. Daser was for some time afraid lest the application of the creosote might induce a gangrenous inflammation of the deep-seated parts; but fortunately no such accident followed. Next day the sponge was again expelled, but without any renewal of the bleeding. Every thing went on well, and the wound was entirely healed by the end of the third week.

The styptic action of the creosote was well marked in the present case. Although highly irritating and almost caustic, the secondary inflammation that followed was very trifling.

M. Daser suggests its application to atonic, varicose, and other unhealthy ulcers.-Graefe's and Walther's Journal.

DISCUSSION AT THE ROYAL ACADEMY RESPECTING OPHTHALMIA.

A few months ago, there was a very lengthened and most elaborate discussion on this subject among the learned members of the French Academy. It was continued during at least five or six sittings, and the Journals of the day exhibited to the reader's eye page after page of the most wearisome, and often too most contradictory, assertions. As is generally the case with field-day harangues, but little light seems to have been thrown upon the question at issue by the numerous and long-spun speeches that were delivered. All, that we propose to do, is to give a brief summary of the speeches of the members who opened the dis

cussion.

M. Velpeau read a report upon a memoir by Dr. Morand of Tours, on an epidemic of Scrofulous Ophthalmia, which had prevailed among the sick prisoners of the Colony at Mettray. The disease had resisted every mode of treatment, until Dr. M., observing that it always commenced with an inflammation of the pituitary membrane, fortunately thought of applying the nitrate of silver to this part, by introducing up the nostrils an ointment-composed of from one to two parts of the salt to 20 parts of lard and almond oil. This plan was followed by the most pleasing results.

M. Velpeau expressed his regret that Dr. M. had not employed an anatomical denomination in place of the very faulty one of Scrofulous Ophthalmia. Since he had read this memoir, he had examined the state of the pituitary membrane in a great number of cases of Ophthalmia; but he had not found any traces of inflammation on it, except in a very few cases. In ordinary circumstances therefore, the treatment of ophthalmia by any application to the nostrils he considered to be certainly not admissible: the practice may however, he thought, be useful in certain cases.

M. Roux desired to learn from the reporter for what reason, and to what extent, he objected to the appellation of Scrofulous Ophthalmia. Does he mean to say that we should not designate ocular inflammations according to the nature of their causes? and that we should have respect only to their seat, and the tissue or tissues which are most affected? Does he wish us to believe that any one mode of treatment,-that by the application of caustic for example is equally applicable to each and all of them, whether the disease have a syphilitic, a scrofulous, a rheumatic, or any other origin?

M. Castel remarked that a Scrofulous Ophthalmia cannot be said, properly speaking, ever to be epidemic; for there is no such thing as an epidemic form or variety of scrofula. It is quite a misnomer to attribute the character of scrofulous to an epidemic ophthalmia.

M. Velpeau said that he had no wish or intention to suppress the appellative qualifications of scrofulous, syphilitic, &c. superadded to the terms which designate the inflammations of different parts of the eye. All that I mean to affirm, he continued, is that we cannot properly, in the present state of ophthalmological science, call one of these inflammations merely scrofulous, and nothing more; this appellation is not sufficient; we must indicate with greater exactitude the tissue that is affected, whether this be, for example, the conjunctiva, the cornea, &c., and then we may add an epithet to characterise its special nature. We should therefore speak of scrofulous conjunctivitis, scrofulous keratitis, &c., instead of employing a vague general term, as that of scrofulous ophthalmia for all inflammations of the eye.

M. Gerdy spoke to the following effect. "The German spirit, which is dominant in the present day in ophthalmic medicine, is essentially retrograde and antiprogressive. Our neighbours divide and subdivide diseases in the most arbitrary way, alike without reason and without measure. The eye is an organ of exceedingly small dimensions, not exceeding 12 or 13 lines in diameter in any

direction. Surely therefore it is difficult to conceive how inflammations, whose character on all occasions is to spread, can be confined to any one of the tissues of an organ, which is altogether so small. The innumerable divisions, endeavoured to be established in the voluminous works of the German writers, do not exist in Nature. I have no hesitation in saying that it is utterly impossible to distinguish such a host of inflammations, such as the spirit of system has attempted to describe. I do not mean to assert that the inflammatory action may not be confined to some one of the parts or tissues of the eye, when it is not severe; moreover I am ready to admit that it may commence in one part or tissue rather than in another; but what I maintain is, that the entire organ necessarily becomes in course of time more or less implicated in the morbid action, as soon as this acquires any degree of intensity. Read, if you have the patience to do it, the fastidious symptomatology that you find in the works of pathological writers, and you will meet, for each variety of ophthalmic inflammation, with a series of phenomena that it is utterly impossible to distinguish at the bedside of your patient. Then again as to the treatment to be pursued, this is generally the same in all cases. But it is not sufficient to point out faults and defects; we must endeavour to show how they are to be avoided and rectified. In my opinion, all that requires to be done is to describe the inflammation of the whole eye, indicating in the most simple manner how this morbid state may be confined in some cases to a single point, in other cases to two points, and so forth. As a matter of course, due attention must be paid to the idiosyncrasy and peculiar constitution of each patient."

M. Velpeau admitted that the infinitude of distinctions enumerated by German oculists is most unnecessary; but he did not go so far in his objections to their style of writing as the preceding speaker. I do not think, said he, that we should reject them all, as he seems to do. Although the anatomical elements are accumulated in the eye, it does not follow that they may not be affected with inflammation separately, at least in the earlier stages of the disease. Any one, who has attentively studied the diseases of the eye, can have no difficulty in distinguishing conjunctivitis, keratitis, iritis, &c. It is quite true that each of these inflammations requires the same remedies for their cure; but this holds true of all inflammations. Shall we therefore say that their particular diagnosis is unnecessary, and of no utility? Certainly not; for, though the general treatment may be alike in all, the local remedies that are required in each are different.-Comptes rendus.

HYPERTROPHY OF THE CARTILAGES OF THE TRACHEA AND BRONCHI. Professor Gintrac, of Bourdeaux, relates the following case in a recent number of the Montpelier Journal of Medicine.

A boy, eight years old, and of a delicate ailing constitution, had been from his infancy affected with a greater or less degree of dyspnoea, which was occasionally accompanied with sharp pains in the chest, and other symptoms of thoracic distress. He had been repeatedly admitted into the hospital; and had generally received relief, at least for the time, from bleeding and the application of blisters between the shoulders. When he entered the hospital on the 24th of May last, his breathing was exceedingly oppressed, so as sometimes-more especially in the evening-to threaten suffocation: there was however no cough present. Auscultation discovered nothing, except a strong sibilant noise in the bronchi; and every part of the chest was perfectly resonant on percussion. There was nothing abnormal in the pulsations and sounds of the heart, save that the former were somewhat more obscure than usual: the pulse too at the wrist was regular. The abdomen was rather full, but the evacuations were healthy.

This state, of which the mos prominent symptom was a constant dyspnoea

every now and then liable to great aggravation-had been but little relieved by the remedies that had been employed, such as enemata of Assafoetida, fumigations of Stramonium, the use of Calomel, Sulphuret of Soda, &c. The child left the hospital on the 8th of July, but was brought back 17 days afterwards; the symptoms then being unusually intense. The suffocative dyspnoea continued up till the period of death, which occurred on the 8th of August.

Dissection. The body was much emaciated, the sternum was very prominent, the thorax was fuller on the left than on the right side, and the face and extremities were œdematous. The lungs were found to adhere to the thoracic parietes, except at the upper part on the left side, where there was present a small quantity of limpid serosity: in every other part the pleura, whose tissue was much thickened throughout, was more easily detached from the ribs and the intercostal spaces than from the surface of the lungs. The larynx was healthy, and so seemed the trachea likewise externally; but, on slitting it open, its parietes were discovered to be much thicker and harder than usual. This alteration was most conspicuous at the lower part, close to the point of its bifurcation: it extended also to the bronchi, for a considerable extent. The result was, that the calibre of the air-passages was very sensibly smaller and more contracted than in a state of health. The lungs were oedematous; for, on dividing them, a quantity of yellowish serosity oozed from the divided surfaces: the lower lobe on the right side was hepatised.

PERIODIC SWELLING OF THE KNEE CURED BY OPIUM.

A middle-aged woman, of intemperate habits, sprained her left foot in February, 1843. Six weeks after the accident, and when it seemed that she had quite recovered from its effects, the ankle-joint and lower part of the leg became suddenly very much swollen, hot and painful: this state continued for a few hours, and then gradually subsided. The swelling, &c. on the next and following days recurred about the same time of the day-two o'clock; and, after lasting for about three or four hours, disappeared. The general health remained perfectly good during all this time.

The periodicity of this affection, and the absence of all inflammatory symptoms, induced me, says the reporter, to order quinine, which was administered to the amount of 15 grains daily: the joint was, at the same time, ordered to be rubbed with a camphorated opiate liniment. These means were steadily continued for six days; but no benefit was produced. The starched bandage was then tried, with the view of preventing the recurrent swelling; but the use of it caused so much pain, that it was at once discontinued. Trial was next made of the affusion of cold water upon the joint, followed by brisk friction: the internal use of sudorifics and colchicum was conjoined with this local treatment; but everything seemed to be utterly impotent. On finding this, I began the use of the Acetate of Morphia. Its effects on the complaint were very speedily manifest: each day the pain and swelling became lets considerable, so that, in the course of a week, the patient appeared to be perfectly well.

On the day however following that when she had discontinued the use of the Morphia, the swelling and other symptoms again made their appearance at about ten o'clock in the forenoon, and continued for nearly the usual time. I wished now to give another trial to the quinine; it was therefore administered in large doses, but again it failed. The Morphia was then taken, and with equally decided effects as on the former occasion. Its use was continued for a fortnight; after which it was suspended, without any return of the symptoms.-La Belgique Medicale.

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