painful as to be allowed only with the greatest reluctance. The examination, as well as it, lead to aching pain afterward, from hip to hip and through the body. There is pain in the back and belly, and the least jar in walking causes her to scream out. Some of this may be due, however, to the caries which exists in the pelvic bones. She has taken a good deal of iodine at irregular intervals, to which, perhaps, the change in the tumor may be owing. Several more cases have come under my observation in private practice; two or three such were seen by myself and Dr. Crane in the Northern Dispensary, and the latter also saw a case in private practice. Prof. Gilman has also met with and treated such an one, successfully. As I am not writing a history, but a sketch only of the affection, I shall leave the symptoms to be inferred from the cases which I have now related, remarking only that they present nothing pathognomonic, but are the common expression of several uterine affections. That each may exist separately and from other causes, I well know, but I leave it to the profession to decide, how far, when they coincide, they are to be considered as in the relation of cause and effect, and how far the removal of the tumor demands our special attention. The neuralgic character of the pain with which they are apt to be associated, merits a passing notice, not less than their frequency, the uncertainty of their nature, their tendency to remain stationary, to grow slowly, or rapidly, to disappear and spontaneously to return, their peculiar predilection for the posterior wall of the uterus, their innocuousness to life, and their insidious development, until revealed under the influences of some stimulus, of which matrimony and the renewal of coitus are conspicuous. Of the causes of the disease I know nothing; for the prognosis, I refer to the quotation from Lisfranc, and leave the diagnosis to the tact and judgment of the reader. A very few words respecting the treatment.

The only remedy for these tumors on which any reliance can, in the present state of our knowledge, be placed, is iodine."

ON THE EXTRACTION OF THE RETAINED PLACENTA IN ABORTION. By HENRY BOND, M.D. (From the American Journal of the Medical Sciences, April).

All authors are agreed that, in cases of abortion, the hemorrhage is kept up by the presence of the placenta, and that, as soon as this is removed, the hemorrhage always ceases-they do not suppose that the placenta is retained by any firm adhesion, but for the want of some means to reach it with safety, and get a secure hold of it. When the placenta projects into the vagina, the introduction of one or two fingers will suffice to extract it. But in the most troublesome and dangerous cases, where the placenta is inclosed within the body of the uterus, and its neck is contracted, the finger can do nothing. Dr. Bond here enumerates a variety of instruments invented by different accoucheurs for the removal of the placenta in such cases, and after pointing out the objections to each, he suggests one of his own invention to which he gives the name of placental forceps. This instrument is about 10 inches long, curved laterally on a radius of about 12 inches, and the blades about 14 inch longer than the handles. The blades terminate in an oval expansion nearly half an inch wide. The handles and blades, including the edges of the oval expansion, are rounded and bevelled off, so as to preclude all possibility of injuring the surrounding soft parts. The inner part of the oval expansion is made concave and rough, so as to maintain a severe grip on the body embraced. The outside of the oval part of the blades is made slightly concave and smooth, without a fenestra, so that, in passing them through the os uteri, and expanding them so as to embrace the placenta, there shall be the least danger of injuring the part.

ON PERITYPHLITIS, OR INFLAMMATION OF THE CELLULAR TISSUE ADJACENT TO THE CACUM, By WM. SELLER, M.D. &c. (Abridged from the Northern Journal of Medicine, July 1844.)

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This disease, which is characterised by inflammatory turgescence adjacent to the cæcum, has its seat external to the peritoneum, in textures of a cellular structure, and, unless neglected at first, is more prone to resolution than to the formation of pus; when suppuration does occur, the pus is almost invariably evacuated by the rectum. Tenderness on pressure, hardness, dulness on percussion, and circumscribed swelling of the abdomen, adjacent to the anterior part of the crest of the right ilium, while the integuments move freely over the tuinor, are the prominent and least variable symptoms of this disease. The part so affected varies considerably in extent. When the swelling reaches across the abdomen towards the linea alba, or upwards obliquely towards the umbilicus, the disease should be suspected of having passed into an inflammation of the peritoneum, or even perhaps of the coats of the bowels. Pain of the upper part of the thigh in front, increased on motion, is either not a constant symptom, or is so trivial in the majority of cases, as to have escaped notice. The functions of the bowels are in general more or less affected. Nausea, vomiting, and anorexia are sometimes among the symptoms, but by no means essential to the disease. Symptomatic fever is not in general well-developed in simple cases the pulse is almost natural; in the severer, it is sharp, hard, or jarring, not often small or oppressed. The disease is apt to come on insidiously; the colic pains, which usually usher it in, may last only for a few hours, or may recur at intervals for several weeks, before the swelling appears. The disease is of uncertain duration. When the precursory period is short, when it is itself uncomplicated, and the treatment appropriate, a cure may be expected in ten or twelve days-a degree of induration, however, generally remains. There exists sometimes a disposition to recurrence. The unfavourable terminations of this disease are suppuration and extension of the inflammation to the peritoneal lining of the abdomen, and even to the coats of the intestines. Resolution is the more common result. Even when it terminates by suppuration, as in the case of abscess of the pelvis after parturition, it is for the most part unattended with serious consequences. To pelvic inflammation after parturition the disease in question bears considerable analogy. Yet active treatment in the early stage is more essential than in the pelvic inflammation-for the tendency to suppuration seems to be proportioned to the neglect of free evacuations of blood. It seems certain that the pus formed in perityphlitic inflammation, sometimes, though rarely, penetrates through the abdominal wall. Such an occurrence, however, is extremely rare.

Dupuytren mentions the case of a young man who had been treated at the Orleans Hospital for a phlegmonous tumor in the right iliac region, which he at first neglected. He passed blood by stool, and his health was partially restored. He then went to Paris, where his complaint increased, the swelling enlarged, and abscesses opened in the right iliac region of a fistulous nature, through which pus and feculent matters were discharged. After a tedious illness of several months, accompanied with cough, diarrhoea, emaciation, &c. he recovered.

In the cases which proved fatal, no evacuation of pus either by the rectum or by an external opening for the most part takes place; but a copious deposit of pus is found on dissection almost uniformly, as far as the reported cases show, along with marks of extension of the inflammation to the peritoneum. Albers and others relate several cases of this disease, and record the several less favourable terminations of it to be; 1, Suppuration with discharge of pus by stool2, Suppuration with discharge by an external aperture; and 3. Suppuration with superadded peritonitis. Dr. Seller relates a case which well illustrates the insidious mode in which this inflammation makes its attack. The patient was a No. LXXXII.

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medical man about 40. Towards the end of July, 1840, being apparently in perfect health, he awoke in the middle of the night with severe griping pain, which continued for two or three hours, and then passed off with a slight evacuation of the bowels. On getting up he felt nothing but a sense of weariness, and of weight and slight tenderness in the abdomen, as if the parietes did not sufficiently support the bowels-he went on for two days without any perceptible aggravation. On the evening of the third day, he noticed a slight pain in the fore-part of the right thigh, which he found to commence in the right iliac region. Next morning considerable pain on pressure in that part-a hard circumscribed swelling, with a dull sound on percussion-bowels free. Constitutional symptoms not well marked, pulse rather frequent, and harsh. Twenty leeches to the swelling with relief-venæsection in the evening to 16 ounces. At night a calomel and opium pill. Next day symptoms abated. Venesection and leeches again. Two days after more leeches, in consequence of some stinging pains in the part. After ten days from the commencement the patient walked out perfectly recovered. The pathological seat of this affection seems to be in the cellular tissue between the fascia of the iliacus internus and coats of the cæcum. This explains why the pus, when produced, so uniformly passes into the cæcum. The iliac fascia, though somewhat variable in character, is for the most part a strong fibrous membrane. Its extent and connexions form, so long as it is free from disease, an impenetrable barrier to the progress of pus outwards. And when we remember that about one third part of the circumference of the cæcum is uncovered by peritoneum, and that the uncovered part is in contact with loose cellular tissue interposed between the iliac fascia and itself, we shall no longer feel any difficulties in understanding the chief peculiarities of peri-cœcal inflammation. The pus is confined on every side by the close adherence of the peritoneum to the cavity which it lines. The alternative is, on the one hand, that pus so confined, almost in a sac, should penetrate through the posterior wall of the cæcum, which is but making its way through a thin partition to a mucous cavity, or, on the other, that it should penetrate through the substance of the iliac fascia, or ascend into the right meso-colon by separating its laminæ, or detaching the peritoneum from the iliac fascia, where it adheres close to it, should make its way into the pelvis. Cases may be instanced in which each of the consequences under the latter alternative has occurred, yet very rarely by comparison, and not probably till the inflammation unchecked had extended beyond its original seat, and destroyed the substance of the fascia, or weakened the cohesion between the lamina of the mesocolon, or that between the peritoneum and the subjacent substance.

OVARIAN TUMOR.

In the Montreal Medical Gazette (April, 1844), is related a case of ovarian tumor bursting into the bowels with ultimate recovery.

A married female, aged 27 years, was delivered of a child in May 1842. On the 22nd November following, Dr. Fraser was sent for, and found her labouring under severe pain in the right iliac and lumbar region, shooting down to the thigh, with dysury. The pain abated; but soon returned. There was fulness in the right iliac fossa, with tenderness to the touch, and febrile symptoms. Leeching and purging rendered the fulness less conspicuous. On the 10th Dec. there was a severe attack of pain, and half-way between the pubis and umbilicus was discovered a well defined tumor, the size of a turkey's egg. There was no swelling or hardness in the original site of pain, and the present tumor was capable of being moved about, even beyond the mesian line. In four days it became the size of a cocoa-nut, with great pain and sense of distention. On the 14th Dec. an exploratory needle was introduced, and three ounces of a straw

coloured fluid evacuated, forming, when cold, a white jelly, when treated with nitric acid. The feeling of distention was relieved for some days, when it returned, and continued for six weeks, with varying paroxysms. The general health had now suffered much, and she became affected with dry cough. The tumor progressed in size, and on the 10th of January, 1844, it occupied a large space, pressing so much on the vagina, that no satisfactory examination could be made. On the 25th Jan. premature labour came on, and she was delivered of a fœtus about four months old. The pain still continued as severe as ever. Feb. 9th, a consultation was called; but the tumor, in the mean time, had burst into the bowels, from which a large quantity of dark, red, and fætid matter was discharged, the discharge continuing for three or four weeks, gradually decreasing, and at length entirely ceasing. The remains of the contracted sac are still to be felt in the lower part of the abdomen. The general health has improved; but the sequel is far from certain. We have some doubts about the precise nature of the disease.

ANTIMONY IN INFANTS. (Provincial Journal, July 1, 1844.)

Mr. Wilton (Surgeon to the Gloucester Infirmary) has drawn the attention of the profession to the serious effects which sometimes result from the exhibition of antimony in infantile diseases. The first case related was that of a child about a year old, to whom the mother had given small doses of antimonial wine for a cold and affection of the chest. Mr. W. found the patient suffering from slight convulsions-pallid sunken countenance-vomiting and diarrhoea. The means employed failed, and the child died. On dissection, the internal and external parts were pale and exsangueous-no vascular patches in the alimentary canalthe brain very soft; but no organic changes anywhere to account for the sudden collapse and death.

A few days afterwards, Mr. W. was summoned to another child, exhibiting similar symptoms, after taking antimonial wine. This child was saved. Some other cases are narrated, of which we shall notice the following. A child, about four years of age, became affected by cold, cough, and febrile symptoms. Saline draughts with antimonial wine were given by the medical attendant. Sickness and diarrhoea followed, with sudden prostration, which ended in death, despite of cordials and stimulants. On dissection, the surface of the body was pallid, and on being moved, a large quantity of colourless fluid flowed from the mouth. The whole body was exsangueous, but no marks of inflammation were anywhere visible.

We have often seen distressing symptoms follow antimony in children, and, except in urgent or croupy cases, we generally prefer ipecacuan, which, if it sickens at all, soon clears itself out of the stomach without injury. Mr. Noble, of Manchester has also published some precautionary remarks in the same Journal on antimony in children, which are worthy the perusal of all junior practitioners.

EUPATORIUM PERFOLIATUM IN EPIDEMIC INFLUENZA. By J. F. PEEBLES, M.D. Petersburg. (American Journal of the Medical Sciences, April, 1844.)

To this herb the domestic name of Boneset was given, from its prompt manner of relieving pains in the limbs and general muscular system, which attended a peculiar form of febrile disease which prevailed many years ago in the northern parts of this country (America). This fact led to the suggestion of its employ

ment in epidemic influenza. It was found that the pain in the back and limbs, and the lassitude of the general muscular system subsided as soon as the system was placed under its influence. Besides this prompt action on the nervous system, the eupatorium perfoliatum united in its operation other qualities, each one eminently adapted to fulfil some important indication in the treatment of the influenza. Among the first of these may be mentioned its diaphoretic powers. In this disease the skin was not unfrequently imbued with perspiration; the perspiration, however, was of a morbid character, resulting apparently from a lax condition of the skin, which under such circumstances was always pale and mor bidly sensitive. Antimonials were ineffectual in removing this state-the opium in the pulvis Doveri checked the other secretions, and was therefore objectionable. Entirely exempt from this objection the Eupatorium not only induced a healthy and free perspiration, but quickly restored the skin to its natural and healthy state, rendering its texture firm and healthy. Under its use also the disposition to cough subsided, and there was an immediate amelioration of all the pulmo nary symptoms. It also proved to be a prompt and efficacious expectorant. It was also found to possess tonic properties peculiarly suited to the treatment of certain cases of epidemic influenza in aged persons.

Manner of Administration.—Where it was determined to treat the disease with the herb alone, the patient after being covered in bed was made to swallow a wine-glass of the infusion, prepared by infusing one ounce of the dried leaves in a pint of boiling water, warm, every half-hour. After the fourth or fifth dose considerable nausea, sometimes vomiting, with free diaphoresis ensued, and there was an immediate amelioration of all the symptoms. Expectoration also was produced. After this relief ensued, and the patient felt very comfortable. The infusion was now given only every third or fourth hour in the same dose. The bowels were generally opened in about six hours after the commencement of the treatment, and remained in a lax condition.

OVARIOTOMY. Dr. CHURCHILL.

Ovariotomy is, just now, a formidable rival for fame, with Mesmerism or Hydropathy. The two former, indeed, ought to go hand-in-hand; for as ovarian tumors seldom grow in any but the patrons and recipients of animal magnetism, it would be a great advantage to those who come under the scalpel, to have its pains and penalties annihilated by the passes of an adroit mesmerist. Be this as it may, the ovarian operation can be tested only by time and statistics-the advocates and opponents steering such opposite courses, and using such ingenious arguments, as to puzzle the practitioner. Statistics will settle the question. Dr. Montgomery has gone into considerable detail on this point, and collected from various points of the compass a mass of materials that may greatly assist our prognosis perhaps even our diagnosis, in these dangerous cases.

Dr. M. properly remarks that, under the head of ovarian dropsy, are com prehended many swellings very different from dropsy. There may be a singleor many cysts-and the contents of the cysts may and do vary from clear serum to an almost wholly solid substance. The ovaries may consist of malignant de posits and last, not least, they may be detached, or they may have acquired extensive adhesions to various adjacent parts, rendering a successful operation all but impossible.

Mr. Southam has published the result of 20 cases of paracentesis-ten from Bright-five from Barlow-and five of his own. Out of these 14 died within nine months after the first operation. Of the remaining six, two died in eighteen months-and four lived for several years, from four to nine.