Operation of P. Roux.-Professor Roux, determined to surpass his namesake, saws out an inch or more of the bone, and then, by drawing the lateral flaps towards each other, diminishes the breadth of that part of the face involved in the disease. Then detaching the flaps, he draws them across the opening in the bone, and the sutures which hold the soft parts are generally sufficient to hold the bones in their proper places.

Operation of Mr. Morgan.-This consists in first removing the entire lip by a semilunar incision, the concavity of which is uppermost; and second, in making an incision also curvilinear and parallel to, and about an inch or more below the first. The skin included between the two is then carefully detached, except at its extremities, and lifted into the place occupied by the diseased lip.

Operation of M. Blasius.-M. Blasius has performed a very simple operation, when the tumor was large: and, according to his statement, with decided success. After removing the diseased mass by a common V shaped incision, he next divided the integuments along the base of the lower jaw by two incisions, which commenced at the entering angle of the V, and extended an inch or more in the direction specified. Lifting the flaps, he made them occupy the place of the original lips.

Operation of Dieffenbach.-This surgeon has recommended an operation apparently hazardous and severe.

"Having pared away the useless remains of the former diseased lip, or separated the cicatrized margin, a horizontal incision, about two inches long, is carried from either angle of the mouth outwards, through the cheeks, so as to throw the mouth widely open. The length of these incisions must be regulated according to the width of the mouth; or, as a general rule, the combined incisions must somewhat exceed in length the breadth of the upper lip. From the outer point of each of these, another incision is next carried obliquely downwards and towards the median line; the section in this case likewise extending through the whole thickness of the cheek. Thus, by means of the first operation for paring the cicatrix, and by the succeeding horizontal and vertical incisions, a flap will be prepared on either side to replace the defective lip; this flap is of a quadrangular form, and maintains a connexion of more than one inch wide with the soft parts covering the tissue of the lower jaw. It may be useful further to separate the mucous membrane at its attachment to the gums to allow of the more ready traction of the flaps."

The severe injury inflicted on the facial nerve, the large arteries and veins, and possibly the parotid duct, has rendered this operation anything but popular.

Operation of Liston.-This consists in first removing the diseased mass by a horizontal and two perpendicular cuts, or by one curvilinear in shape; and, second, in detaching a flap from the chin and neck, twisting it on its pedicle, placing it in the seat of the original lip, and there retaining it by suture. After adhesion has taken place, the pedicle is divided, and a wedge-shaped piece removed so as to allow the flap to be laid down smoothly. This method, it is obvious, is frequently applied to the restoration of other parts, and will answer here exceedingly well in many cases. Dr. Mütter, however, prefers the following operation, "as there is less scar, and less risk of sloughing of the flaps."

Dr. Mütter's Operation. Having first removed the diseased mass by a semielliptical incision, two slightly curved incisions are carried from the centre of this line, downwards and outwards, to the base of the inferior maxillary bone. Then, from the terminal extremities of these incisions, two others are carried upwards and outwards along the base of the lower jaw until they reach a point

opposite the initial and terminal points of the original semilunar incision. Two quadrangular flaps are thus marked out, and immediately detached from the subjacent bone. These flaps are then raised and placed in the position originally occupied by the lower lip, and then united to each other at the mesial line, and also by their lower thirds to the triangular piece of integument, (left between the two lines which started from the centre of the semi-elliptical incision) by means of the twisted suture. By the elevation of these flaps, a raw surface is left on each side to heal by the modelling process or by granulation.

ON THE TREATMENT OF THE INFLAMMATORY AFFECTIONS OF MALARIOUS DISTRICTS. BY WILLIAM M. BOLING, M.D. (American Journal of Medical Sciences.

Dr. Boling considers that a peculiarity of the febrile excitement produced in the system by, and accompanying local inflammations in those residing in marshy districts is, that it has a tendency to assume the intermittent or remittent type, as malarious fevers not connected with local inflammations have. Another striking peculiarity about these inflammations, he continues, is the obstinacy with which they resist what is generally considered purely antiphlogistic treat

ment.

The treatment adopted by Dr. Boling consists in the administration of free doses of quinine, not indeed as the sole remedy, but combined with the use of gentle laxatives occasionally, and mild antiphlogistics. Under these remedies it appears that fewer fatal cases occurred, and convalescence was rendered less tedious, than under the usual line of treatment; at which we are the less surprised, as it appears that, according to the old system, the physicians used to "take pride in boasting of their hundred-grain doses of calomel, or the number of drastic pills given in a dose."

The Dr. candidly confesses that he has been able to form no very satisfactory opinion as to the modus operandi of quinine; "the observations of one day generally altering or modifying the opinions predicated upon the experience of a previous day." As a general rule, however, he considers it to act as a sedative or contra-stimulant; more certainly reducing and controlling the action of the heart and arteries than any remedy with which I am acquainted." In some cases, on the other hand, it appeared to act as a stimulant.

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A great many cases are related in which quinine was administered, usually in doses of about forty-eight grains in the twenty-four hours. As in one of these cases in which the quinine was administered, apparently with benefit, it was pretty evident that malaria had no agency, the author inclines, towards the end of the Essay, to alter the opinion with which he set out, viz., that it was only on patients labouring under the poisonous influence of malaria that the sedative action of the medicine was exerted, and to consider "that under any circumstances the quinine may be made to act as a sedative by merely proportioning the dose to the degree of inflammatory action going on in the system at the time."

The Dr., not wishing to ride his hobby very severely, concludes by confessing that," as an antiphlogistic remedy in elevated and healthy localities, it (quinine) will probably never supersede the lancet, antimonials, &c., though it may, in many cases, be brought to their aid; but in malarious regions, ere long, it will generally be looked upon as the safest and most manageable contra-stimulant we possess, and at the same time one sufficiently powerful, while other agents of the same class will only be used to fulfil some casual indication, or as adjuvants to this, the principal remedy."

ON AN ACCIDENTAL FIBROUS TISSUE OF THE NECK OF THE UTERUS, AND PARIETES OF THE VAGINA. By Dr. E. PERAIRE, of Bourdeaux. (Gazette Médicale de Paris, Aôut 31).

The distinctive character of this formation, according to the author, is, that whatever the part on which it forms, the accidental fibrous tissue presents a membranous aspect. It may assume various and very irregular forms; sometimes there are found concentric layers which envelope the neck of the uterus, and assume a capsular appearance. At other times, the membrane takes an angular form; there then appears, starting from a point perfectly distinct from the neck of the uterus, a fold which, traversing its tissue, is extended upon a portion of its surface, and forms, by the separation of the fibrille which compose it, an angle of varying degree; the disposition of this tissue may be compared with that which is seen in the ocular conjunctiva at the inner canthus, when it takes an angular form. Finally, the accidental fibrous tissue presents itself in the vagina in the form of separate or united bands.

With regard to the manner in which these tissues are formed, the author does not appear to be at all clear; he thinks, however, that in several cases of inflammation of the body or neck of the uterus, or of the parietes of the vagina, he has found a state of engorgement of the sub-cutaneous glands, and that this engorgement was of such a nature as to provoke a secretion somewhat resembling varnish, extending itself upon, and even beyond, the diseased parts.

If this fibrous tissue occupies a considerable surface, and has taken the capsular form, it may cause atrophy of the neck of the uterus. In other cases, where it is of less extent, it occasions changes of position in the uterus, either total or partial; it may also give rise to a modification of nutrition in the affected organ.

Treatment. As this accidental tissue has a great tendency to contract, and become an inelastic band which impedes the free exercise of certain functions, the author considers that prompt treatment is requisite. The administration of medicines internally is of but little service; the author recommends therefore an early recourse to surgical operation. If the tissue present the capsular aspect, the membrane must be circumscribed by a simple circular incision, along its greater circumference, taking care that the incision along the neck of the uterus, and not at its implantation into the vagina, and still less on the vagina itself; the incision ought not to be of any depth. After the blood has been allowed to flow for a short time, the wound is to be touched with nitrate of silver; and some simple dressing applied. Suppuration soon becomes established, and the membrane is detached either entire, or in fragments after a short time. This operation is more complicated than when it is only necessary to incise the tissue at one point of the circumference of the neck or of the vagina. For partial adhesions of the uterus to the vagina, a straight bistouri is used to cut from without inwards, and a curved bistouri in other cases. It is necessary in all cases to respect the rectovaginal septum behind, the vesico-vaginal septum in front. If any membranous bridles exist in the vagina they must be destroyed either by the long scissors or by the bistouri.

Miscellanies.

RELATIVE FREQUENCY OF PULMONARY PHTHISIS.

DR. BOYD has published the following curious statistical report from the St. Marylebone Infirmary.

"From 1428 examinations, it was found that 28 per cent. had tubercles in the lungs nearly 24 per cent. had tuberculous matter in the bronchial and cervical glands, and 84 per cent. enlarged and tuberculous mesenteric glands. Tubercle was more common among males than females.

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"Of the males, nearly 36 per cent. and of the females, 21 per cent. had tubercles in the lungs; the proportion at different ages was as follows :—

"No satisfactory explanation has as yet been afforded why males should be more liable to pulmonary consumption than females; occupation alone is not sufficient to account for the great difference, as we find, from the above, the same disparity to exist even in childhood.

"The weights of the internal organs in phthisis were all above the average in both sexes. The disproportion was greatest in the lungs, which were nearly one-half heavier. The effect of age upon the organs seemed to be to diminish their weight.

"The weight of the body of the male adult consumptive patient was nearly onethird less than the average weight of the male adult in the workhouse; as the internal organs were all above the average weight, the great decrease in the weight of the body must have been in the muscular structure, tissues, and framework.

"Height.-The mean height of 107 male adult consumptive patients was five feet seven inches, and of 63 female consumptive patients, five feet two inches.

"The mean height of 160 female adult paupers in the workhouse, the majority from 35 to 50 years of age, was five feet and of an inch, and of 141 male adult paupers, a little more than five feet three inches.

"Hence, it appears that the consumptive females were 1 inch, and the consumptive males nearly four inches above the average height of other individuals belonging to the same class. It would be interesting to observe the relative height of healthy and consumptive individuals of both sexes, and of all ages, belonging to a different class, and occupying a different locality. Mr. Hutchinson, in a paper read before the Society of Arts on a pneumatic apparatus, has, from numerous observations on male adults of different classes, established a law-viz. for every inch of height from five feet to six, eight additional cubic inches of air at 60° are given out by a forced and full expiration.'

"Herbst found that adults of large stature, when breathing tranquilly, inspire and expire from 20 to 25 cubic inches; persons of smaller stature 16 or 18 cubic inches.'-(Vid. Müller's Phys. Part I, second edition, p. 313.)

"Does the rule laid down by Mr. Hutchinson, that persons, in proportion to

their height, expire a greater quantity of air, afford any explanation of the foregoing results, that tall persons are more subject to consumption than short persons, under similar circumstances, and males more liable to the diseases that females? The greater depth of the chest and consequent length of lung, together with the specific lightness of the air, facilitating its accumulation and detention in the cells at the apex of the lung, in which part tubercles are most apt to collect, and become usually first developed.

"It deserves inquiry what may be the modifications of form-what the degree of elongation in the lungs of tall persons, and whether the air inspired under such circumstances may not render them more subject to the effects of any deleterious properties mingled with that air than shorter persons similarly situated.

"Of 60 healthy children measured-30 males and 30 females-from 3 to 7 years of age in the workhouse, the average height of the males exceeded that of the females by two inches, and the liability to pulmonary tubercles among the males at that age has already been shown, from 294 observations, to be more than 9 per cent. greater than among the females of the same age.

"The difference, as may be seen, is still greater after puberty, from 20 to 60 years, the period of life at which the males are obliged from their employments to use more bodily exertion than the females, and consequently to make greater demands on their pulmonary organs.

"As age advances, and consequent inability to exertion, the difference in degree to which the two sexes are affected is less even than it was in early life. "The results respecting the relative frequency of phthisis in the two sexes, are directly opposite to the results obtained by M. Louis at La Charité; according to the observations of that distinguished physician, the frequency of phthisis among men in relation to women, was as 72 to 95.-(Annales d' Hygiene, t. vi., p. 51.) The fact is interesting, because it appears probable that the relative frequency of consumption in the sexes, of subjects nearly in the same class of life, differs essentially at St. Marylebone Infirmary, London, and La Charité at Paris.-Dublin Medical Press.

A MEDICAL PORTRAIT.

Our Contemporary of the Dublin MEDICAL PRESS, has drawn a portrait of the medical profession in England, which we, after forty years' experience, could not recognise, or, as Jonathan would say, realize. After alluding to the "comparative purity of the profession" in the Emerald Isle, "as contrasted with its condition in England," the reviewer proceeds :-"Here (Ireland) still, the body at large, of physicians and surgeons, is entitled to the rank of a profession-there (England) it is a trade, and, compared with other trades, not by any means the most respectable." The great body of physicians and surgeons in England will certainly be a little surprised-and not very much flattered by this information that they are only second chop tradesmen! "How can it be otherwise?" (says our polite contemporary) "into no other profession, business, or calling, in any degree entitled to be considered respectable, can a man obtain admission with less means and less general education. Whoever can scrape together about fifty pounds in the course of a few years, and can obtain his board and lodging for his work at a druggist's, while engaged in what is called his studies,' can, without difficulty, obtain a surgical diploma." Indeed! The Council of the College in Lincolns-in-fields will prick up their ears at this piece of news-and even the College of Apothecaries in New Bridge Street will stare at it. It is abundantly clear that our contemporary has travelled into a country of which he is perfectly ignorant; for we cannot believe that he had wilfully and knowingly