patient voided his urine pretty freely-which he had not been able to do for thirty-six hours. The weakness and cramps in the lower limbs continued for some time afterwards; but these also subsided in the course of a few days.Annali Univ. di Medicina.

Remarks.—If our readers will turn back to the Number of this Journal for April 1839, they will find some very interesting observations, by Dr. Giocomini of Padua, on the subject of poisoning with Cantharides. He shews that this substance exerts a powerfully contra-stimulant and hyposthenic effect on the system; and therefore that the proper remedies to be administered, in cases of poisoning with it, are stimulants and cordials.

Besides this article, there is another in one of the subsequent numbers, wherein M. Orfila (we believe) has described a good many experiments where animals were poisoned with Cantharides; and in these also it was found that the chances of recovery were always in proportion to the freedom with which stimulants had been administered.

The fear of administering stimulants in cases of poisoning with acrid substances is too common. It should be remembered that the great object of treatment, in such circumstances, is to combat and overcome the tendency to death; and, therefore, that our practice should be regulated by the nature of the symptoms that are present, and not by our suspicions of the pathological lesions that may have been induced.

A TENIA EVACUATED THROUGH AN OPENING IN THE ABDOMINAL PARIETES.

Bremser, Rudolphi, Cruveilhier and others, have questioned the accuracy of the recorded histories of lumbrici making their way through the parietes of the intestines; but the more recent researches of M. Mondiere would seem to prove indisputably the perfect authenticity of the alleged fact, and to shew

1. That Lumbrici may work themselves a passage through the parietes of the intestines, by simply separating the fibres of these parietes by means of their head or anterior extremity;

2. That, by reason of the contractility of the muscular fibres of the intestinal parietes, the opening, which has given passage to the worm, is immediately obliterated, and leaves no perceptible trace behind;

3. That, in consequence of this arrangement, a verminous tumor, when it opens outwardly, cannot communicate directly with the cavity of the intestines; 4. That a verminous tumor may be formed at any point of the abdomen, but that it is most commonly developed about the inguinal and umbilical regions.

Instances of the discharge of Tæniæ in this manner are of much more rare occurrence. Only two cases are on record, as far as we are able to ascertain. One is related by Mouleng in the Journal de Medecine, tome LVI., and the other by Sporing, in the Memoires de l'Acad. des Sciences de Suede, tome IX. In both these cases, however, the presence of fæcal matters in the verminous tumor, and the permanence of a fistula after the discharge of the tænia through the abdominal parietes, induce the belief that the worm had made its way outwardly through an ulceration of the bowels.

The following fact, recorded as it is with all necessary details by Professor Siebold, serves to make it probable that a tania may traverse the parietes of the intestines by merely separating their fibres, in the manner that lumbrici are in the habit of doing.

A young man was received into the surgical hospital in consequence of several scrofulous abscesses on different parts of his body. A tumor, which was sup

posed to be of this nature, occupied the umbilical region. A few days after his admission, Dr. Herz was in all haste summoned to the patient, as the swelling had suddenly burst, and given issue to a tænia, which was alive and moved about quite freely. It was cautiously laid hold of, and slowly and very gradually drawn out to the extent of several ells. No gas, chyle, bile or fæcal matter escaped from the opening; in short, there was nothing to lead to the suspicion that the verminous swelling had any communication with the cavity of the intestines.Medicinische Zeitung fur Heilk. in Preussen, 1843. No. 17.

M. CAZENAVE ON ALOPECIA, OR BALDNESS.

The causes of this lesion or defect are numerous and varied. It is very common after small-pox and other severe febrile affections; also in the course of phthisis and other protracted diseases. Whatever attenuates and exhausts the powers of the system, is sufficient to induce it. Thus, it is not unfrequent among prisoners and the inmates of workhouses, gaols, &c.; and who does not know that intense or long-continued mental application and moral emotions of a depressing character cause the hair to fall off, as well as change its colour from dark to sober grey?

Baldness appears to be sometimes owing to a syphilitic taint. There has been a good deal of difference of opinion among medical men on this point; but M. Cazenave thinks that there cannot be a reasonable doubt on the subject. And let it be understood that he does not allude merely to the form which has been attributed to the action of mercury on certain constitutions, nor yet to that which not unfrequently occurs when there is an actual venereal eruption, whether tuberculous or squamous, present on the scalp at the time; in such cases there is not any reason to attribute the falling off of the hair to the constitutional nature of the disease, rather than to the local presence of the tubercles or pustules. But what M. Cazenave means by Syphilitic Alopecia is a genuine secondary symptom, which may occur without any co-existing farinaceous exfoliation, or other manifest disease of the cutaneous tissue. This species of Alopecia is not so rare as is generally imagined. Among other cases, M. Cazenave mentions one that may be worth noticing. It occurred in a middle-aged man, who had been affected with gonorrhoeal inflammation of the testicle. At the end of four months, and without the appearance of any other secondary syphilitic symptom, the patient lost almost all his hair, which was strong and of a dark colour. The Orchitis remained for a long time imperfectly cured; a relapse of the disease occurring every now and then. When recourse was had to the steady use of mercurial frictions, it was observed that the hair of the head ceased to fall off.

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Alopecia is not unfrequently caused by the cutaneous affections which have been called herpes tonsurant, porrigo decalvans and pityriasis capitis, and by other squamous diseases. The scalp becomes the seat of an inflammatory action, which betrays itself sometimes by a more or less copious formation of scales, and at other times by the eruption of red papulæ or patches, which are followed by the exfoliation of the cuticle. This dermoid inflammation does not affect either the bulb or the piliferous tube; but the hair, being surrounded and girt, at its passage through the skin, by inflamed tissues, so as to be compressed in a sort of squamous channel, becomes dry and friable, and then breaks off; in this manner the part becomes gradually bald either spontaneously, or in consequence of over-combing and brushing it. Such is the nature of pityriasis capitis -an affection, by the bye, that is perhaps the most frequent in those women whose hair is dark, long and thick. It is very generally aggravated by the use of those very means, that are used to remove the scurf and scales. M. Cazenave

has often had occasion to observe it in ladies who suffer much from neuralgic headaches. As the pilous bulbs remain unaffected, the hair often grows again; but only, at least in most instances, to fall off with greater readiness than before.

All the acute diseases of the hairy scalp-from Erythema and Erysipelas to Eczema and Impetigo-may induce a more or less complete state of baldness; and, as the dermoid inflammation sometimes penetrates to the piliferous tubes, the capsules or bulbs may eventually become seriously affected. This is especially apt to be the case in those impetiginous eruptions that are known by the name of tinea. As a general remark however it may be asserted that the baldness, which supervenes upon any acute affection of the scalp, is of short continuance, and that it rarely and only occasionally happens that the bulbs are destroyed, or the piliferous tubes obliterated. To this form of the disease, we may refer the baldness that is often induced by venereal eruptions-a variety of the disease that is very different, as we have already noticed, from the genuine syphilitie Alopecia.

The baldness, that ensues upon tinea favosa, seems to be owing to the obstruction of the piliferous tubes, and to the consequent obstacle that is presented to the passage of the hairs through them. Hence it often happens that, during the continuance of this disease, the scalp over a considerable extent exhibits a white and shining aspect, without any distinct follicular orifices, and with perhaps only a few scattered hairs. Now this state of the skin cannot at all properly be regarded as a cicatrix of the skin, but rather as a new tissue, very thin in substance, devoid of colour, and having, in consequence of the obliteration of the sebaceous orifices, lost its natural polish. But, if the piliferous tubes have been obliterated, the bulbs have not been destroyed. Hence we can easily discover with the lens, if not with the naked eye, the hair which, under this sort of transparent cicatrix, is about to issue at several points from the external envelope which it cannot pierce, and under which it is sometimes seen to bend upon itself, until it becomes atrophied and the bulb along with it.

The causes of Baldness being so various, the treatment of the complaint must necessarily be different in different cases. The first thing to be done is to determine whether the skin be actually diseased or not. If the falling off of the hair co-exists with a healthy state of the integument, the cause of the complaint must be sought for in the general or constitutional condition of the patient. Its nature is very often manifested by the existence of certain concomitant symptoms, such as the presence of headaches, certain exanthematous eruptions, &c. If there be any local affection of the scalp, the diagnosis, at least for all practical purposes, is obvious: it is to the existing eruption that our attention must be directed; for the baldness is only the result of it; and, by removing the cause, the effects will gradually pass away.

When we have reason to believe that the bulbs of the hair are fairly atrophied or destroyed, it is evident that we cannot reasonably expect to remove the baldness. If this be the effect of a deficient secretion, and the expression of a particular constitutional condition, the case will require a two-fold plan of treatment, one local and the other general. Repeated shaving of the head should be enjoined; for this process seems not only to produce a very beneficial local excitement, but also to render the function of secretion more active.

In the baldness, which sometimes supervenes upon tedious recovery from accouchement, as well as upon fevers and many chronic maladies, we have only to use one or two very simple remedies, as for example dry rubbing of the scalp, to induce the re-growth of the hair-never forgetting, as a matter of course, the restoration of the general strength by appropriate treatment.

Very different is that which is required in that form of Alopecia which is accompanied with the loss of the colour in the scalp-as we see in cases of vitiligo and porrigo decalvans. Here we must trust almost exclusively to special reme

dies; such as stimulant ointments and lotions-the immoderate and ill-timed use of which, in other forms of the complaint, so often does much more harm than good.

In Syphilitic Alopecia, the internal use of mercury or of the Ioduret of Potassium is necessary for the cure.

Whenever there is an exanthematous eruption present on the scalp, the remedies applied must be suited to the nature of the existing local affection, according as this is inflammatory or not. In Pityriasis Capitis, the local affection is usually of an inflammatory nature, and it must be treated accordingly. A very common and pernicious error is, that in such a case we should endeavour to excite the energy of the bulbs, and stimulate the secretion of the hair by those very means, which, by aggravating the inflammatory action, necessarily increase more and more the evil they were expected to relieve. All irritating applications should be avoided; and, when the inflammatory condition of the scalp is corrected, we may then with advantage have recourse to the use of an ointment composed of a little borax and lard, blended well together: a weak alkaline solution also will be found useful in many cases. All sorts of warm and tight head-dress should be most religiously avoided; and benefit will generally be obtained from the regular use of tepid bathing.-Annales des Maladies de la Peau.

M. LISFRANC ON HEMORRHOIDAL TUMORS.

Hæmorrhoids cannot properly be regarded as erectile tumors. They are formed by a sort of fibrous tissue which is traversed by blood-vessels, that are liable to become every now and then more than usually swollen and congested. However great the congestion may be, the vessels in hæmorrhoidal swellings are never so numerous as in properly-so-called erectile tumors.

In several thousand cases, says M. Lisfranc, in which I have extirpated the lower part of the rectum, I have scarcely ever met with a truly erectile tumor in this part.

The non-erectile nature of hæmorrhoidal tumors renders our prognosis much less unfavourable, and renders unnecessary, in the treatment of them, the operation that is usually indispensable for the cure of erectile tumors.

As to the treatment of hæmorrhoids, we have to attend to many circumstances for the regulation of our conduct. If they are in a state of inflammation or painful congestion, we should first determine whether the symptoms be remittent or permanent. In the former case, we should be on our guard not to check suddenly any discharge of blood from the anus, more especially in such habits as are of an apoplectic tendency; for, indeed, a hæmorrhoidal hæmorrhage often seems to serve the same purpose in the male system as the catamenial does in the female. If, however, the pain becomes very severe, or if the hæmorrhage is so profuse as to demand the interference of the medical man, the question occurs: should we, as is so generally done, have recourse to the application of leeches to the anus? This treatment will certainly answer tolerably well on some occasions; but most frequently the local congestion is thereby aggravated rather than remedied. What we should do in such circumstances is to draw blood from the arm to the extent of ten, twelve, or sixteen ounces, on the first day; and perhaps repeat the operation to the extent of four or six ounces on the following. The use of a warm bath will much promote the good effects of the bleeding. If the introduction of the canula up the rectum does not produce much pain, an enema of nearly cold water, to which a few drops of laudanum should be added, is a very useful remedy. No poultice should ever be applied to the anus, as it only serves to increase the congestion of the already overswollen vessels.

When the hæmorrhoidal tumors are protruded through the anus and are constricted and perhaps partially strangulated by the sphincter, how should the surgeon proceed to reduce them? It is generally recommended that he first smear his fingers with oil or some other unctuous substance. Such an advice must surely have been given by one, who is not acquainted with practice;-for the protruded tumor is usually too slippery, and we require to wipe its surface before attempting to replace it. The object and endeavour should be to push gently backwards and upwards, first, that portion of the gut which was last protruded, and so on gradually until the whole is re-introduced. If the patient strains much during this operation, his attention should be distracted as much as possible.

Let us now briefly notice the treatment of hæmorrhoidal tumors when they are in a chronic condition. If they are readily reducible and are not attended with pain or any great inconvenience, they are generally excised, without much consideration as to the risk which the patient may thereby run; for it never should be forgotten that the extirpation of hæmorrhoids is not wholly devoid of danger. For myself, I generally avoid operating in such circumstances; and, being convinced that surgery, when it effects a cure without the loss of blood, is a thousand times more brilliant, I avoid, as frequently as possible, having recourse to the use of cutting instruments. For the purpose of diminishing the size and fulness of hæmorrhoidal tumors, I enjoin a mild and soft diet, cooling drinks, and occasional spoliative or derivative bleedings. When this treatment is insufficient, I find an excellent adjuvant in directing a stream of cold water upon the anus, or even up the rectum. We often effect a cure by this means; and in almost every case the general health of the patients becomes, at the same time, decidely improved. When we cannot command the use of the douches, we have found a useful substitute for them in gently touching the surface of the protruded hæmorrhoids with the nitrate of silver, with the view of stimulating and not of cauterising them. The bourrelets usually shrink up in consequence of the excitation induced, and do not again protrude.

If the hæmorrhoidal tumors exhibit simple ulcerations, they should be cauterised with the nitrate of silver, or with the acid nitrate of mercury. If the ulcerations are of a decidely unhealthy nature, and the tissues be indurated, the diseased part should be excised. To guard against the excessive, and sometimes fatal, hæmorrhage that may occur after this operation, I recommend the following plan:-let the hæmorrhoidal bourrelet be first laid hold of and drawn out by a tenaculum, and surrounded by two elliptical incisions; in place then of removing it by one or two sweeps of the knife or scissors, it should be detached slowly by successive strokes at different points of its circumference. By adopting this method, the blood-vessels, as they are divided, are prevented from being retracted upwards: they can therefore be secured either by ligature or by torsion. When I come to the point of the circumference of the bourrelet at which I begun, I lay hold of the mass to be divided between my thumb and fore-finger, in order to find out if it contains any artery which may be easily commanded; and then I detach it very cautiously and leisurely, dividing it by successive strokes of the bistoury. Even this operation is, it must be confessed, tedious, painful, and occasionally followed by fatal consequences.-Gazette des Hôpitaux.