but constantly escaped from the grasp of the in

strument.

M. Barrier and myself ascertained successively the position of the pencil in the bladder; we endeavoured, without success, to remove it by seizing it by one of its extremities, but we were always opposed by an insurmountable obstacle to its extraction. During three various trials, we ascertained that the lithotrite of Civiale, which quickly emptied the bladder, would not seize the foreign body, but pinched the mucous membrane of the bladder; the polypus forceps closed upon the mucous membrane of the urethra, and brought away with them small shreds of the mucous membrane. The lithotrite à percussion" caught the foreign body with facility, brought it to the vesical orifice of the urethra, without being able to disengage it, on account of its transverse position. The patient was carried to bed.

instruments through the female urethra, which,
when united, are larger than the ordinary ca-
theter; it is not, therefore, applicable to the same
circumstance in man, on account of the differences
in length, diameter, and dilatability of the male
urethra. The theoretical distinction between the
modes of operation in the male and female must,
therefore, be evident,

is manufactured for ordinary use. It is also well calculated for promoting either a local or a general diaphoresis it stimulates the vessels of the skin, and, by relaxing the surface, opens the constricted mouths of the perspiratory tubes. As an auxiliary, therefore, to the various sodorofic remedies we have at our command, many of which have a tendency to act on the I have found the great advantage of using two urinary organs, unless proper caution be taken lithotrites in fixing the foreign body, and searchto keep the surface of the body warm, it will ing for its point, or, to speak more exactly, one be of very great importance. By enveloping of its extremities, with much greater certainty than the body in it, either with or without a wicker when one only is employed. With the finger in- frame work intervening, and then passing betroduced into the vagina, the point at which the neath it by means of a metallic tube, on the lithotrite has seized the foreign body, its transverse principle of Dr. Gower's sudatorium, a stream or oblique position, and the distance of the point of hot air, a most profuse perspiration may be grasped by the instrument from the orifice of the obtained in a very short space of time; indeed, bladder, are easily ascertained. As soon as we are much more quickly than with blankets. certain that the instrument is near one of the ex-vapour-bath may also be given in the same way, will be kept perfectly dry. In exciting a return and with this advantage, that the bed clothes of the cutaneous exhalation from parts where it has become suppressed, it is likewise exceedingly efficacious.

In the plan which I have described and followed, the instruments were introduced three times: the two first were without success; the last brought away the pencil. If a similar case should happen, I should simply change the position of the two instruments in the bladder; it would be easy to disengage the first lithotrite, to grasp again the foreign body with it on the right or left, until the most convenient point for removal without injury was seized, and to disengage the second instru

ment.

A

From what has been already said of its properties, I think we may fairly conclude that it will also prove a very valuable adjunct to our ordinary means of resuscitation in cases of drowning. The object here being to restore warmth and animation as quickly as possible, it is evident that the more effectually the temperature of the hot blankets, the bags of heated sand, and of the bottles of hot water, &c., as well as the caloric that may be communicated from them to the body, can be prevented from being car ried off by the surrounding atmosphere, the more speedy will be the effects they are required to produce. All that requires to be done in these cases is, to surround the asphyxiated person with the "piline" after he has been previously enveloped in the warm blankets, and has had the heated materials above alluded to applied along the course of the spine and to the extremities. Hot air may likewise be had recourse to with advantage, in the manner already recommended.

Sept. 18. She has suffered much from the at-tremities, the blades are closed, the other instrutempts of yesterday; the hypogastric pains are ment used to fix the foreign body removed, and, augmented; there is frequent micturition; the finally, that which has grasped the extremity. A urine thick, muco-purulent, and mixed with some little lateral motion may be used, such as that of clots of blood. M. Barrier, going out of town for the midwifery forceps, with advantage. a few days, left her in my charge. I renewed the attempts at extraction, after having thrown an injection of warm water into the bladder. I was not more successful than my colleague in using the same means and instruments, to which I added the long curved forceps, used for extraction of foreign bodies from the oesophagus. I then decided to try a manoeuvre, which appeared theo. retically to be likely to be successful, and by which I eventually succeeded in the removal. Introducing A small infantile lithotrite into the bladder, I ascertained the presence of the pencil; I seized and held it fixed behind and beneath the pubes, ascertaining its transverse position and the impossibility of advantageously modifying it. Confiding this to the care of an assistant, who held it steady, I glided along it another similar instrument into the bladder, with which I seized the pencil at a point to the right of that at which the former had grasped it; removing the first instrument, I ascertained by vaginal examination that I was near to the extremity of the body, situated at the left of the bladder (on my right). Nevertheless, it was not at the extremity which caused the obstruction. I then introduced a second time the same lithotrite, for the purpose of seizing the pencil as near possible to its point, on the right of that which remained in the bladder; again examining by the vagina, I found that the teeth of the lithotrite ..had grasped the left extremity of the foreign body, which scarcely projected in the bladder; I then withdrew the second-introduced instrument, 1 then the last, which brought out the foreign body, Surgeon to the Western Germau Dispensary, and formerly inflammatory affections, particularly of the chest

with it. It was a reddish, unvarnished, cylindrical, common pencil, of ten centimètres length and eight millimètres diameter, formed of two unequal parts glued together. These two pieces separated immediately after extraction. One end was 1 cut, the point broken, the lead forming a slight projection on the other end, with two notches. The pencil itself was covered near its end by a yellow layer of urinary deposit. The patient walked to her bed delighted with the result of the

9.

operation.

I prescribed a hip-bath; cataplasms to the by

pogastrium; linseed tea as common drink, and a 3d sedative draught.

19. No fever; the patient has slept well; frequent desire of micturition; turbid urine. Hip

baths, oily enemata, frictions of the hypogastrium, with camphorated oil, with morphine, linseed ptisan; injections of the bladder with decoctions of mallow and poppies.

20 to 24. The treatment continued; the nourishment gradually increased; the patient has isen, walked about, and the appetite and sleep have returned; the urine is not passed above four times in the day, and has become clear.

24. A catheter introduced into the bladder does not cause the slightest pain, and draws off a limpid arine. The patient was now discharged.

The plan followed in the case above detailed depends in principle on the possibility of passing

I propose to apply the plan of using two lithrotrites in this manner for the extraction of all long and rigid foreign bodies, for the removal of which the introduction of a single instrument is found insufficient. We may, perhaps, sometimes succeed with the forceps with three branches of MM. Bianchetti and Spella, which are more applicable to soft and flexible bodies, or with the lithotrite alone; but, by combining two lithotrites in the manner I have described, we proceed rationally on certain mechanical principles; and we shall obtain in similar circumstances, no unforeseen obstacles intervening, as certain a result as in any of the regular surgical operations.-Gaz. Méd., Nov. 21.

A FEW REMARKS ON THE USES OF
A NEW MATERIAL, CALLED THE
IMPERMEABLE PILINE.

By ALFRED MARKWICK,

Externe to the Venereal Hospital, Paris, &c.

In a paper on "Moist Heat as a Therapeutic
Agent," published in the Medical Times for
November 14, I pointed out the advantages of
the "Impermeable Spongio Piline" as a medium
for applying warm fluids to the surface of the
body. I now propose to introduce to the notice
of the profession another equally valuable ma-
terial, which will be found admirably adapted
for the different and various purposes for which
Piline," a beautifully soft waterproof woollen
it is intended. I allude to the "Impermeable

fabric, from which several articles calculated
to be extremely useful in numerous cases may
be made.

The "Impermeable Piline" may be used either
in the dry state, or moistened in the manner to
be hereafter mentioned.

As a dry application it will be found extremely available in various diseases. In rheumatism it has proved eminently successful in affording, in several instances where I have tried it, very speedy and effectual relief. Nor will it, I apprehend, judging from one case in which I have used it, be less useful in gout. For gangreena senilis it appears to me to be admirably adapted, and, indeed, far superior to the cotton wadding that is now commonly resorted to in this affection; the material intended for this purpose being somewhat thicker than what

Several other instances of the usefulness of this material, in the dry state, might be adduced; but those just mentioned will, I am sure, be sufficient to enable my readers to supply them. I will, however, make a few remarks on it when used in the moistened form; that is, as a vehicle for stimulating liniments.

Wetted with strong compound camphor liniment, I have found it an admirable means of producing counter-irritation, or even a blister. Hence, as a speedy remedy in various internal

and abdomen, and in many diseases of the joints, it will be very valuable. I have known a blister to be produced in this manner in the short space of five minutes; and, when we consider that, almost from the very moment of its application, its stimulating action commences, and that the epispartic result is obtained without any injurious effect upon the urinary organs, such as stranguary for instance, we can but feel convinced

of its importance as a therapeutic remedy, if not of its superiority, in many cases, over the comConsidering, therefore, the various uses to which mon blister ointment or the acetum cantharides. this material may be applied, and the numerous cases in which it may be advantageously had recourse to, there can be no doubt, I think, of its proving of great value to the profession. I might have brought forward several instances in

confirmation of my statements respecting it, but I have preferred confining myself to the simple narration of facts, feeling convinced they will be verified by all who may be disposed to test the truth of my assertions.

19, Langham-place.

OBITUARY.-Nov. 22, at Springbank-cottage, Strathaven, G. Hamilton, Esq., M.D., late surgeon in her Majesty's 72nd Regiment. Nov. 22, at Newcastle, I. Raines, Esq., M.D., of Burton Pitsed in Holderness.

The protrusion of any of the abdominal viscera from their proper cavity into a sac formed for them by the peritoneum, which is pushed before them, is the most common species of hernia that we meet with, though the protrusion of any viscus from its proper cavity is comprised equally under the same name. Hernia may be divided into three kinds-reducible, irreducible, and strangulated. Reducible hernia is that in which the intestine is capable of being returned into the abdominal cavity, though the sac may have contracted adhesions, by its external surface, to the surrounding tissues. An irreducible hernia is that in which the sac has not only contracted adhesions to the surrounding tissues by its external surface, but the intestine has also contracted adhesions to the, interior of the sac, thereby ren. dering reduction impossible. A strangulated hernia is one which may eventually become reducible, but which, for the time being, is incapable of being so, from a stricture being made on the prolapsed part of the gut by the aperture through which it passes, and which requires an operation to divide the stricture, if all other attempts to reduce it fail. There may be some rare instances, where the constitution is strong enough to go through all the stages of strangulation, subsequent inflammation, and sphacelation; the sphacelated portion of intestine being voided through an abscess in the abdominal parietes, and an artificial anus being formed. Few persons can go through all this; whereas, when the operation is performed in good time, very many are saved by it. There are various kinds of hernia, but the most common are the inguinal and femoral. Inguinal hernia is of two kinds-oblique and direct. Oblique inguinal hernia follows the exact course of the inguinal canal. The intestine first passes through the internal abdominal ring, pushing before it a pouch of peritoneum, which constitutes the hernial sac. It then distends the infundibiliform process of the transversalis fascia, in which fascia the internal abdominal ring is situated, about midway between the spine of the pubis and the anterior superior spinous process of the ileum, and about an inch above Poupart's ligament. From the circumference of this ring is given off the infundibiliform process, which surrounds the testicle and spermatic cord, forming the fascia propria of the latter, and constituting the first investment of the hernial sac. The intestine now passes beneath the arched border of the transversalis, and then the lower border of the internal oblique; it here receives another covering from the cremaster muscle, and then arrives at the aponeurosis of the external oblique, in which is situated the external abdominal ring, through which aperture it passes and receives as its covering the intercolumnar fascia. The coverings of an oblique inguinal hernia, therefore, arethe peritoneal sac, infundibiliform process of

fascia transversalis, cremaster muscle, intercolumnar fascia, superficial fascia, and integument. The spermatic canal, serving in the male for the passage of the cord, and in the female for that of the round ligamant, is about an inch and a half in length; it is bounded in front by the aponeurosis of the external oblique, behind by the fascia transversalis and conjoined tendon of the internal oblique and transversalis, above by the arched borders of the transversalis and internal oblique, and below by the grooved border of Poupart's ligament; and at each extremity by one of the abdominal rings. The epigastric artery lies on the inner side of the neck of the sac, or internal abdominal ring. In direct inguinal hernia, the in

testine forces its way through the conjoined
tendon of the internal oblique and transversalis,
just behind the external abdominal ring; the con-
joined tendon may, however, be pushed before the
intestine, instead of having it burst through it. In
this variety of hernia there is no connection with
the cord, consequently it has not the cremaster
muscle for one of its coverings, which are other
wise the same as in oblique inguinal hernia.
The epigastric artery runs externally to the neck
of the sac, and the spermatic cord generally lies
on its outer side; whereas in the other it is
most frequently found behind it. If we always
met with the exact symptoms, and found that
diseases ran the same courses which are described
in books, the study of our profession would be
rendered comparatively easy; but this is not the
case we seldom meet with any thoroughly well-
defined cases, they are almost invariably compli-
cated; and there are certainly no surgical cases
to which this remark applies more strongly than
to hernia. The first case which I have selected
to illustrate this subject is that of Charles Wridg-
way (case 1). This was a case of oblique inguinal
hernia, of six years' standing, which had become
strangulated. He was admitted with all the usual
symptoms of strangulated hernia; he had been
bled largely, and the taxis tried without avail before
his admission. The warm bath and the applica-
tion of ice were employed, but unsuccessfully; and
he operation was performed, the symptoms of
strangulation having existed for twenty-four
hours. There are certain rules laid down in books
with regard to the position of parts in these cases;
but here we find a great deviation from such rules,
and the case is rather a singular one: the vas
deferens was anterior to the tumour, and the sper-
matic artery was posterior to it. The stricture
was exceedingly tight, but it was divided, and the
gut, having regained its natural colour, was re-
turned; the omentum, having contracted adhesions,
could not be returned, and was, therefore, left as
it was found. The symptoms of strangulation
were relieved, but he was attacked afterwards
with peritonitis, which frequently follows, and
but too often terminates in a fatal result. This
man's pulse was small, sharp, and wiry-one
which warrants and requires depletion, and
not that weak, thread-like pulse, which utterly
forbids it. He was bled, and the effect proves
the above-mentioned fact: the pulse rose
and became full, soft, and easily compressi-
ble, and the pain was relieved.
evening his pulse relapsed into its former state,
and the pain increased; he was again bled,
and with the same happy result; the peritonitis
was now checked, and he eventually recovered.
With regard to the application of cold in this case,
it is a well-known fact that the incarceration in
many of these cases depends either upon an accu-
mulation of air or fæces in the hernia; cold will
often cause the bowel to act on the matter contained
in it, or will lessen the volume of air; it will make
the scrotum corrugate and the cremaster contract;
and will often, by producing such effects, serve to
reduce the hernia without any further means.
There is a variety of the oblique inguinal hernia,
called the congenital, and so called, because in
almost all cases it occurs at or soon after birth;
a portion of bowel or omentum descends with
the testicle, and passes with it into the tunica
vaginalis, which consequently forms the hernial
sac. This species of hernia, though it usually
happens soon after birth, is not always peculiar to
that period of life; it has been known to occur in
adults, and last year I saw a case of this kind in a
patient fifty-four years old. This case was com-
plicated with hydrocele, and previous to his ad-
mission he had been tapped for the latter, and was
then advised to go into the hospital, as there was
a rupture remaining. No doubt, in this case,
the fluctuation of the fluid, the tenseness of the
tumour, and the difficulty of distinguishing the
testicle, led to the mistake, no symptoms of
strangulation having then appeared. The trocar,
however, instead of passing into the covering of
common hydrocele, would in such a case pass into

The same

a

a hernial sac, this being formed by the tunica vaginalis. This man had only had hernia for six years, and it was of that kind which is scarcely ever seen except in early infancy; yet there is no reason why there should not be an occasional malformation about this part of the human frame, or why the communication between the tunica vaginalis and abdomen should not continue open in the adult subject, rendering him liable to a protrusion of the bowel into this part, on the operation of the usual exciting causes of hernia; in fact, such communication has been found in the adult without any protrusion. In inguinal hernia, the bowel protrudes above Poupart's ligament; in femoral, always below it. The hernia first protrudes through the crural ring, which is bounded externally by the femoral vein, internally by Gimbernat's ligament, behind by the os pubis, and in front by Poupart's ligament. The hernia then passes behind the falciform pro. cess of the fascia lata, it next passes through the saphenic opening of the same fascia, and then, as it increases in size, it turns up over the falciform process, and is placed on the anterior surface of Poupart's ligament, and does not descend on the thigh. It is of the greatest importance to recollect this circumstance in using the taxis: for the direction which the hernia takes is downwards, forwards, and then upwards; the taxis, therefore, must be applied in exactly the reverse order. The coverings of this hernia, from within outwards, are-peritoneal sac, septum crurale, fascia propria, cribriform fascia, superficial fascia, integument. This kind of hernia is more common in females than in males, on account of the greater breadth of the female pelvis, and the larger size of the femoral arch. When this hernia becomes strangulated, the symptoms which arise are much more severe than those which occur in in guinal hernia, and this arises from the denser and more unyielding nature of the parts which sur, round the neck of the sac. The case of Harriett Barwick (case 2) well illustrates this subject; the hernia came down at six P.M., this was very soon followed by vomiting, and at eight P.M., she was admitted with all the symptoms of strangulatedfemoral hernia. All attempts to reduce the hernia failed, and at twelve P.M., the operation was performed; the stricture was divided, and the gut returned without difficulty. The symptoms were relieved, and in this fortunate case the wound healed by the first intention, and within a very short time she was enabled to leave the hospital.

Mary Sears (case 3) was admitted on the 27th of January, with strangulated femoral hernia, the gut having been strangulated since the 21st. Constipation and vomiting had lasted all this time, therefore the operation was at once determined on and performed; the stricture was divided, and the gut returned easily. In this case, though the gut had been strangulated for six days, it was only slightly discoloured, whereas in many cases it would have been in a state of sphacelation. A short time after the operation, it was discovered that there was a great deal of oozing from the wound, and it was necessary to apply pressure for a

considerable time to stop it. It seemed, however, from her account, that she was of a hemorrhagic disposition, which would account for this secondary hemorrhage. The bowels acted after the operation, and she seemed to go on well till the next evening, when she complained of pain in the bowels, and at half-past nine P.M., died. On examining the body after death, there was scarcely anything to be found which could account for that event; but from her having been in very bad health, and in a very weak state, it might be supposed that her death was caused by the check which her nervous system had received by the operation. As I have stated before, a hernia, though it may become strangulated, does not in all cases require an operation; and we have a good example of this in Mary Holyman (case four), where the symptoms of strangulation had existed for twenty-six hours: she had been bled, and the taxis applied ineffectually, previous to her admission; she was put into a warm bath, and, on

6

by

the

THE MEDICAL TIMES.

her becoming faint, the hernia was easily reduced. The two next cases, though fatal in their termination, are very interesting, and well illustrate this dangerous malady. Louisa Delisle (case 5) was admitted with symptoms of strangulated hernia, and, all attempts to reduce it having failed, the operation was had recourse to. The stricture was exceedingly tight, but it was divided, and the gut returned; there was some fear that a portion of the omentum, contained within the sac, would slough, and accordingly, a ligature having been This poor applied round it, it was removed. creature was a governess, and unfortunately became acquainted with a scoundrel of a Frenchman, who married her for the sake of the little property she possessed; he sold all she possessed, and deserted her, leaving her without the means of procuring even the common necessaries of life. The want of proper nourishment, and the distress of mind which such an event would cause, must necessarily have rendered her very unfit to undergo an operation, and, therefore, the fatal result could She was attacked with not be wondered at. peritonitis, but of a very different kind to that which occurred in Charles Wridgeway; it was of that low kind which is so difficult to treat and so often fatal, and in which general bloodletting is totally inadmissible. Mary Ann Wescott (case 6) was admitted at the same time as the last-mentioned patient; she also was a weak subject, and ill fitted to undergo an operation; this, however, was absolutely necessary, and it was therefore performed. It was extremely difficult in this case to return the gut when the stricture was dilatedfirst, on account of the part of the gut which had been strangulated; and secondly, on account of the omentum being adherent both to the sac and the gut. Mr. Lawrence has remarked, that a hernia of this kind cannot be reduced; and, though this was reduced at the time of the operation, it was soon dragged down again into its old situation by the omentum, and was there found after death, showing that, though this kind of hernia may be reduced, it is almost, if not totally, impossible to prevent it from coming down again, which renders it almost the same kind of thing as an irreducible hernia. This patient was attacked with low peritonitis, and died much in the same manner as Louisa Delisle. In cases of strangulated hernia, it is always necessary to examine all the weak points at which a hernia is likely to occur, and the necessity for so doing is well shown in the case of Anne Dudley: she, like the other patients mentioned above, was admitted with all the symptoms of strangulated hernia; and all that could be discovered was a large umbilical hernia, which could easily be returned, but immediately protruded again. The symptoms of strangulation had existed for seven days, and there was great prostration of strength, with a rapid, weak pulse, and constant stercoraceous vomiting. All the apertures were carefully examined, and, no other hernia being found, the tumour at the umbilicus was cut down upon, but no strangulation was discovered in this place. She died, and then the mystery was solved: a small knuckle of intestine was found to have passed through the right femoral ring, and had there become strangulated; it was in a state of sphacelation, and must have been so when she was admitted; and this, from rendering it flaccid by allowing the escape of its contents, prevented the discovery being made before her death.

REVIEWS.

A Practical Treatise on the Diseases Peculiar to Women. By SAMUEL ASHWELL, M.D., &c. Highley, London. Second edition. The second edition of this work has just made its The great merits of the production appearance. and really great merits they are too-are, that it is large without being distended; that its language is plain without being abrupt or affected; and that its whole burden is to point a practice rather

than adorn a theory. All honour to such works
as these. Palmam qui meruit ferat. Ay, though
for a brief season the chaplet be woven for the
brow of the most visionary, and men be thrust into
the rear in the ratio of their practical utility, the
time is not far distant when the line will be found
turned, and the rear and the van changed places.
We do not wish to deny the merits of "Young
Physic" in toto-very far from it—indeed, we
readily admit that many noble minds are of its
number, that may some day do "the state some
service"; but, inasmuch as we hold that all the
pen-and-ink chemists together are not worth half
a laboratory man, so do we maintain that a whole
university of study doctors are not to the pro-
fession they should exalt, the science they should
cultivate, or the humanity they should benefit,
worth the umbrella of the educated attendant at
the bedside. What have we got from the former?
-doctrines of a day. What from the latter?-great
facts for all days. And so do we welcome this
book right heartily: it teems with what we may
term cultivated experience. If it take any views
different from what we have formerly maintained,
it has good right to do so, because it comes of a
source that would venture nothing in idleness or
speculation-that has already achieved too much
eminence to hazard prima facie.

But to come to the book. System (the want of
which makes so many otherwise worthy books
valueless) is not the least commendable feature of
it. It is divided into two parts: the first compre-
hending functional, the second organic, diseases;
and these again are subdivided into chapters ac-
cording to a very natural arrangement. We may
open the book at hazard to show our author. We
have done so at chapter iii., part 1.

"ON VICARIOUS MENSTRUATION.
"DEFINITION.-A discharge, generally of blood,
from other parts than the uterus, superseding
menstruation, and, in its return, occasionally ob-
serving a menstrual period.

"History and Symptoms.-This vicarious discharge
can scarcely be regarded as a disease, when the
hemorrhage does not really derange and exhaust
the system. Dr. Locock calls it a curious freak
I think he is right in doing so for
of nature.
the process, in most instances, equally wants the
It is an event entirely
regularity of a healthy function, and the injurious
influence of a disease.
out of the ordinary course: for, although it is
scarcely ever met with except in connection with
amenorrhoea, still, by far the greater number of
instances of this latter malady are unaccompanied
by vicarious discharge. Generally, it occurs in
the unmarried, at least my observation warrants
When married women
this conclusion; but quite as often in the weak and
delicate as in the robust.
are its subjects, conception rarely takes place
during its continuance; although an interesting
case, in which pregnancy more than once sus-
pended the vicarious discharge, is recorded by Dr.
Davis. Sterility, depending principally on torpor
of the organic system of nerves, may likewise be far-
ther ensured by the amenorrhoeal state of the uterine
lining membrane incapacitating it for the forma-
tion of the decidua. The vicarious discharge is
usually blood, but it may consist in an excess of the
natural mucus of the genital organs, constituting
leucorrhoea. Some portion of the pulmonary and
intestinal mucous tissues are thought to be the
more common seats of the vicarious loss; but
certain it is that the nipples, the ears, the gums,
the umbilicus, the bladder, the axilla, any part of
the skin or the mucous membranes, or the surface
of an open ulcer, may occasionally by gush, but
more usually by slow transudation, for several days
furnish the vicarious blood. In the regularity of
its periodical return it seldom resembles the
healthy function, although cases are recorded where
the menstrual epoch has been exactly observed.

disturbance is generally slight, and the amount of
subsequent constitutional disorder is only propor-
mammæ are the seat of the hemorrhage, there is
tionate to the blood lost. When the nipples or
often the formation of a crust over the affected
"The time during which vicarious menstruation
spot, which being thrown off, the bleeding occurs.
may continue to be repeated is very uncertain.
I have admitted patients into Guy's, expecting its
reappearance, and, after keeping them in the ward
for many weeks, have been completely disap-
Local pain, consti-
pointed, the amenorrhoea persisting, and the vica-
rious flow not returning.
tutional irritability, and hysteria, are often
premonitory of its periodical approach; and in a
patient, who was subsequently a nurse in the hos-
pital, the surface and edges of a large menstrual
ulcer on the thigh were invariably more painful,
hot, and swollen, prior to its furnishing the vica.
rious evacuation. There are cases on record, by
Churchill and Siebold, where excessive salivation
has supplied the place of the catamenia. Such an
instance I have never seen."

Passing over causes, diagnosis, and prognosis,

we come to

"Treatment.-The extent to which remedies may
the hemorrhage, the effects of the loss, and the warn-
be employed must be determined by the amount of
ing of it approach. If the process has been repeated
frequently, and there are premonitory symptoms,
emmenagogues may be used, if there be no ple-
thora or congestion. If, however, there is en-
or loins, leeches to the os uteri, vulva, or anus,
gorgement of the uterus, cupping on the sacrum
must precede the use of any stimulants. A smart
drastic purgative may not only prevent the vica-
rious attack, but also induce menstruation; and I
have several times, after preliminary depletion,
witnessed the good effects of electricity, and the .
strong mustard hip-bath at a high temperature.

"If the hemorrhage, having come on suddenly
and without any previous indication, is moderate,
interference is unnecessary, the advantages of
healthy menstruation being partly secured by it.
But if, on the contrary, a large quantity of blood
is lost, and from an organ important to life, then
similar measures must be adopted as in hemor-
rhage, not vicarious. The infusion of roses, with
and bismuth, the acetate of lead, ergot, turpentine,
nitrate of potass, dilute acid and digitalis, cubebs
and opium (vide formula), may be exhibited.

"In the intervals, the treatment must be directed to the removal of the amenorrhoea: tonics, and at Tunbridge Wells, Malvern, Buxton, or Matespecially iron, ought to be given. A residence lock, or by the seaside, is often decidedly advantageous."

In the second part of the work, under "Simple "Treatment.-This will, of course, be deterulceration of the cervix and os uteri," we have the following judicious treatment recommended :mined by the stage and severity of the affection. If the patient has been so early examined as to not exist, it may yet occur, venesection may in Local depletion, some instances be advised. induce the belief that, although ulceration does may be abstracted by cupping from the loins or however, will be indispensable; and the blood about the sacrum, or by leeches to the perineum and vulva, the effect being increased by the hipbath. In all such instances, excepting the cervix is exceedingly painful on pressure, or so enlarged, tense, red, and shining as to lead to the conviction that an abscess is about to burst, leeches directly applied to it, or scarifications as herebefore recommended, are far more efficient. A few weeks since, I saw a case where matter had formed, the cervix being enormously enlarged, hot, and indurated. I had previously wished to slipper-bath at 100 deg. for nearly an hour, I scarify, but, after keeping the patient in the "It has been assumed, but without sufficient punctured the most projecting part, and more proof, that, before furnishing the vicarious dis- than a table spoonful of pus escaped. There was charge, the part must be in a disordered, irritable, rather extensive subsequent ulceration, but the or weak condition; but it has been frequently ob-healing was rapid and quite satisfactory. An incause of suppuration. served that, so far from structural change taking jury from a pewter injecting syringe was the place in the vicarious organ, even its functional

1

"Whether local bleeding be practised or not, the recumbent posture, hip-bath of salt water, or medicated with poppy and conium, should be diligently used. Mila aperients, a spare diet, and sexual abstinence must be enjoined. Where the ulceration is slight, astringents, or three or four drachms of the oxide of zinc, in six ounces of distilled water, used as an injection three or four times daily, will often cure. Various ointments may be recommended, and mercurial cerates have ealed many ulcerations when there was no syphilitic taint. It will be inferred, from what I have already said in the chapter on Cancer, that I fully concur in the great utility of cauterizing these diseased surfaces.

"M. Lisfranc, generally so daring, seems inconsistently timid about the application of caustic. He regards engorgement of the uterus, and inflammation of the vagina or cervix, as events sufficiently important to forbid its use: the very affections which I have cured by cauterization, when other remedies have entirely failed.

“M. Lisfranc, with equal want of judgment, prohibits it where there is subsequent pain; while, with more reason, he thinks that its application should be interdicted for four or five days before and after menstruation. The protonitrate of mercury has succeeded better in his hands than any other caustic. Jobert employs the pernitrate, and Delpech the acid nitrate, of mercury. After a careful examination of remedies and their effects, I find none more efficient than the common lunar caustic, of varying strength and accurately applied; the general health, and especially the condition of the bowels, require attention.

"Several times within my knowledge, the happiness of married life has been seriously interfered with by the pain in coitu' consequent on slight or more severe ulceration of the cervix. Such instances are, for manifest reasons, long neglected; nor is it till the evil becomes really almost intolerable that an examination is permitted. Sometimes the cervix is only abraded, its mucous surface being so irritable and tender that every repetition of intercourse brings with it a repetition of the abrasion, bleeding, and pain. Practitioners will, I know, recognise in this brief allusion, the facts of similar cases of their own, long neglected, because not thoroughly examined. Many of these I have healed by frequent and slight cauterization with the nitrate of silver, and in some of them the cure has been attended by immediate restoration of the sexual feeling, which had been long entirely absent. In a case of this kind, where the lady came from a foreign country to England for advice, the whole disease consisted of a pustular ulceration, the invariable and immediate consequence of intercourse. The harmony of the parties had been destroyed, and the utmost incredulity evinced when I stated that there would be but little difficulty in the cure. The recumbent posture, the lunar caustic, and oxide of zinc, with sarsaparilla and good diet, effected permanent improvement; and when I last heard of the patient, then living in Hungary, she was perfectly well,

and about to be confined.

"Far more frequently than is generally supposed, painful intercourse, and eventually sterility and broken health, are dependent on acute and chronic inflammation and congestion of the cervix. Such cases from time to time fall under my care; and, though most of them are curable by proper treatment, often have I to regret that a delicacy of feeling, which can hardly be too much commended, and a want of a due appreciation of its importance by the attendant practitioner, have together prevented that examination, without which the cause of the

malady remains unknown, and the only effective treatment neglected. Not unfrequently do such evils continue for years, till disappointed hopes of cure induce a permission properly to investigate the disease. I trust that the suggestions now made will be sufficient, and that I shall, for manifest reasons, be excused for not dwelling at greater length on a class of cases avowedly not uncommon, and exceedingly important."

It is impossible to do justice to such a book by

This is a very interesting assemblage of cases,
drawn up with much care, and discussed in their
pathological bearings with a nice discrimination
and judgment. Dr. Kennedy has acquitted him-
self most excellently of his task, and produced, CASE 1.-B. R., aged forty, was admitted into
within the compass of a pamphlet, what cannot St. George's Hospital, in May, 1846, with a large
fail to be both attractive and useful to the profes-tumour, apparently of a carcinomatous nature, con-
sional reader.

nected with the back part of the left foot. The The following case of fever and delirium, the disease had existed about a year, and had lately result of mental emotion, is very curious:- been rapidly increasing in size. With the exception "J. N., aged twenty-six, chimney-sweep, left of the tumour, the patient appeared to be in a good his house in the morning, in perfect health, to state of health: there was no dyspnoea, no dema assist in sweeping chimneys at Beggar's-bush-in fact, no symptoms of visceral disase. Ten days Barrack. While engaged at his work, he was in after admission the leg was removed. The tumour the act of falling from the roof of a high building, appeared to be of an encephaloid nature, and had when he saved himself by clinging to a spout, apparently begun in the os calcis. Six days after from which he remained suspended until his the operation, the patient died with symptoms of strength was well-nigh exhausted before assistance secondary inflammation of the pleura. At the exarrived. On his return home, about two o'clock, amination of the body marks of extensive recent he appeared quite well, detailed to his family with inflammation were observed about the left pleura perfect calmness all the circumstances connected and pericardium. The right cavities of the heart were much dilated, with hypertrophy of the walls with the accident, but continued to recur freof the left. In the right auricle was a large growth, quently, during the course of the evening, to the 'providential escape' he had had from death. which, proceeding from the appendix, occupied The following morning he was.admitted in high the greater part of the cavity of the auricle, and, passing through the auriculo-ventricular opening, fever, with violent delirium. He lived twentyeight days, having become completely paralysed for some time before his death. The delirium continued from the time of his admission till a short time before he died, when consciousness returned for a little, and he recognised his wife. The disease, in the suddenness of its onset, and in the course of its progress, exhibited some features of delirium tremens; but, on inquiry, it was ascertained that he had always been a man of remarkably temperate habits." (P. 19.)

In connection with the subject of delirium tremens, our anthor remarks

"Dr. Cless, of Wurtemburg, has called the at-
tention of practitioners to the remarkable and,
according to him, truly specific effect of digitalis
in this disease. Of thirteen patients labouring
under this affection, and treated by the infusion
of digitalis, two only proved unsuccessful. It
would appear from the accounts, that the fa-
vourable results were owing to the narcotic effects
of the remedy." (P. 19.) Dr. Kennedy has not
been able to confirm these observations by his
own experience, having never administered digitalis
alone in delirium tremens. For ourselves, judging
of the pathology of this disease, and the treat-
ment usually most successful in it, we should
seriously doubt the propriety of treating it with
digitalis alone, or even in combination with other
medicines. What narcotic power it possesses is
very feeble, and very likely the result of its
sedative action-an action by which it is chiefly
known to us. The infusion is particularly cha-
racterized thus; and how it can be beneficial
where stimulants and opiates are, for the most
part indicated, is to us a mystery,

We have much pleasure in recommending Dr.
Kennedy's excellent pamphlet to our readers.
The First of a Series of Lectures on the Actual Con-
dition of the Metropolitan Graveyards. By G.
This is another of the pamphlets of the indefa-
A. WALKER, Surgeon, &c. &c.
tigable Mr. Walker, with the old purpose. The
lecture is full of important facts, given lucidly, and
accompanied with an earnestness of good feeling
that must command respect.

APOTHECARIES' HALL.-Gentlemen admitted
members Nov. 26:-Thomas Beswick Purchas,
Alfred Brooks, Arthur Priest, and Thomas James
Sturt.

projected some distance into the ventricle. When cut into, this tumour presented a highly vascular appearance, and in structure resembled exactly the encephaloid disease of the foot, for which the

patient's leg had been removed. The valves were

healthy in structure. No carcinomatous disease was found in any other part of the body. Some pus existed in one of the veins of the stump.

CASE 2.-M. H-, aged fifty-nine, was admitted into St. George's Hospital, Dec. 10, 1845, with a tumour of the breast, apparently of an encephaloid nature, and some enlargement of the absorbent glands. The countenance was anæmic and of a yellowish colour, but the patient was cheerful, and presented no symptoms of disease, beyond that of the breast. A red blush of an erysipelatous character existed in the skin covering the breast, and extended to some distance. Under existing circumstances it was deemed advisable, not to meddle with the disease. The tumour gradually increased in size, and ultimately the skin broke, giving passage to a large fungous growth. Some six weeks after her admission into the hospital, she was one day seized with urgent dyspnoea aud partial syncope, and died on the following day. No symptoms of disease had existed about the chest up to the day preceding her death.

At the examination of the body the tumour proved to be of an encephaloid nature; the disease had spread up to the glands of the axilla. A small encephaloid tumour was also found in the left rectus abdominis. The cavities of both pleurae contained a quantity of clear serum; the lungs were healthy; the heart was enlarged by dilatation of its cavities, the dilatation of the left auricle being more marked than that of the other cavities; the mitral valve was slightly contracted, and there was some thickening of its tendinous cords. auricular surface of this valve was extensively covered with a soft deposit, which, to the naked eye, presented all the characters of encephaloid there being merely an aperture the size of a quill disease; the opening of the valve was all but closed, for the passage of the blood. The semilunar valves was healthy; no cedema about the extremities. were slightly thickened. The abdominal viscera

The

The portions of the diseased structure, both of the breast and the heart,which were examined by the microscope, presented large nucleated but no caudate cells.

The author, after stating that both these cases presented rare powers of carcinomatous disease

about the heart, called the attention of the society more particularly to the second case, in which was a well-marked specimen of encephaloid disease of the free surface of the endocardium, an affection rarely met with; so sarely that Dr. Walshe in his treatise on cancer alluded only to one case, which was of a doubtful nature.

After a quotation from Roskitansky, who states that encephaloid deposit does sometimes occur about the valves of the heart, the author called attention to the curious fact of the patient in the first case having undergone a most severe operation, without ever evincing any symptoms of the extensive disease which existed about the heart.

Dr. Golding Bird inquired if any examination had been made before the operation to ascertain the condition of the viscera.

Mr. Hewett said that no examination had taken places, because no signs of disease in the chest were apparent.

Dr. Watson said it was best in all cases to examine the chest, although no suspicion of disease there might exist.

Mr. Lloyd said that at St. Bartholomew's Hospital, the chest, in such cases, was always examined.

Case of Peritonitis with Purulent Effusion; Spontaneous Evacuation of Pus through the Abdominal Parieties; Recovery. By C. S. B. Aldis, M.D., Physician to the London and Surrey Dispensaries.

The subject of this case was a little girl, aged

seven, whom the author saw for the first time on June 5. At this time the abdomen was greatly dis

tended, with umbilical protrusion and fluctuation. A small swelling, with thick parieties, was observed between the margin of the ribs and the umbilicus on the right side. It was reported that eleven weeks previously, the child had been attacked with chilliness, followed by heat and vomiting, with pain in the belly, feverish symptoms, and delirium. The tumefaction of the abdomen first appeared in

about four weeks.

cervical vertebra. Death occurred forty-eight hours
after receipt of injury.

Mr. Solly brought forward the case as interesting
in a physiological rather than in a practical point
of view, and particularly as being against some
recent arguments tending to show that the anterior
and posterior column of the cord do not perform
the same office as the roots of the nerves conneeted
with them.

The symptoms were those of complete loss of motion, while the sensibility of the skin was at first much exalted, though it became natural before death. The author drew attention to the incessant vomiting from which the patient suffered, and which he seemed disposed to attribute to irritation of the sympathetic nerve by the rough surface of the fractured body of the vertebræ, as shown in the post-mortem examination. The examination was performed cighteen hours after death, the weather being cool, and showing there was sanguineous effusion into the muscles at the lower and

ent to that of the antelor, and from their passing so deeply into the interior it may be inferred that the part of the cord which bestows sensibility is situated deeply. These views throw light on a fact which must have been frequently observed in cases of disease or injury on the spinal marrow-uamely, that the power of motion is commonly lost before sensation; the explanation of which seems to be that the morbid action affects the columns of motion situated superficially, before it can reach those of sensation placed more deeply in the cord. In regard to the proofs which may be drawn as to the exact columns of the spinal marrow which confer sensation, from tracing their roots of the fifth cerebral nerve to their origins, some dissections described by Sir Chas. Bell, in his latter papers to the Royal Society, seem to be of peculiar interest. The fifth nerve resembles the spinal nerves in having two roots-one of which bestows motion, and the other sensation : it arises at the base of the brain from the side of the pons posterior part of the neck, and fracture of the fifth varolii, apparently at a very remote distance from cervical vertebra, extending through the arch on the spinal marrow. It is well known, however, to the right side, and thence through the body of the anatomists that the larger root, proved to be that bone, also on the right of mesial line the fractured which confers sensation, has its real origin from a edge of the body presented a rongh surface forward point which may be considered the commencement branches of the sympathetic nerve, which were red ribbon-like band of medullary matter, which forms into the neck, and was in contact with some of the spinal marrow. On following the thin, flat, and stained with blood. The intervertebral cartilage the proper cut downwards through the medulla was torn and separated between the fifth and sixth oblongata, Sir Charles Bell was satisfied that it cervical vertebrae. The joint was open between their did not pass in the direction of the posterior articulating processes, so that there had been a column of the spinal marrow, and that it had no complete dislocation of thirteen bones of the spine connection with that column; he observed that it above and below. On examination of the cord took a more lateral course, and disappeared in a there was no lesion perceptible to the sight; but by track which he regarded as the continuation of the placing the knife carefully across its anterior sur-posterior lateral column. From the same column face, and carrying it from above to below, it sank in he found the posterior roots of the spinal nerves between the fourth and fifth cervical nerves, show- arising, and he consequently inferred that it is the ing that the cord was softened at this part. Pos-posterior lateral column, and not the posterior, teriorly there was no alteration in the surface, which is the source of sensibility in the cord. did not exhibit any change in the colour of the mewhich was uniformly firm. A transverse section dullary portion. The cineritious was of a deeper MEDICAL SOCIETY OF KING'S COLLEGE,

and rather redder colour than natural. In texture
antero-lateral columns, these being quite soft and
there was a great change in the anterior half of the
pulpy. All between the posterior lateral groove and
the posterior mesial groove was firm and elastic, like
the rest of the cord. A small portion of the pos-
terior third of the antero-lateral column was also

After a careful examination of the abdomen, no enlargement of any of the viscera could be perceived. The motions never contained any purulent matter. From the history of the case, and the present symptoms, the author believed it to be one of peritonitis with effusion; the swelling above mentioned being an effort of nature to evacuate the effused fluid. On the 8th of June, about five firm; but there was not a distinct line of dequarts of pus escaped through a perforation of the marcation between the soft and normal parts of the cord. This alteration in texture did not exabdomen occurring naturally in the swelling. tend more than a quarter of an inch in the longiAfter this the abdomen was uniform in appearance; tudinal direction of the cord. Above and below no tumour nor remains of a cyst could be traced. The discharge continued more or less until the 31st this point the cord was uniformly firm and normal. of July, when it had nearly ceased. The author The brain was perfectly healthy and firm throughout. A short discussion followed, chiefly on the lost sight of the case until the 14th of September, bearing of the case; and Mr. Shaw made the folwhen he found she was in perfect health. A cica-lowing observations in reference to the question of

trix had formed where the discharge issued.

The author concluded by remarking, that the case was interesting from the unusual occurrence in children of such a termination of peritoneal inflammation. Dr. Lee had informed him, that he had met with several cases of puerperal peritonitis terminating as the above, but has never met with a similar instance in children.

Dr. Watson observed, that purulent matter, the result of peritonitis, was uncommon, whether in relation to children or adults.

Dr. Alderson doubted whether the case was peritonital, as he could not find in the report the symptoms usually attending peritonitis.

Dr. Aldis had not seen the case till eleven weeks after peritonitis existed; he could not give a more particular account of it than he had done in the report. There was tenderness on pressure, and vomiting, swelling of the entire abdomen, and fluctuation. Five medical gentlemen had seen the case, and regarded it as one of peritonitis. Dr. Lee had seen and even met with three instances of collection of matter, the result of puerperal peritonitis.

Case of Traumatic Paraplegia, with the post-mortem
Examination. By S. Solly, F.R.S., Senior As-
sistant Surgeon to St. Thomas's Hospital.
In this case paraplegia resulted from injury to
the spinal cord, caused by fracture of the fifth

the functions of the posterior columns of the spinal
marrow; that two cases had been recently pub-
lished in the "Transactions of the Society," where
the facts were opposed to the conclusion of Mr.

Solly-that these columns bestow sensation. In
one published by Mr. Stanley, the patient, having
lost the power of motion, retained sensibility, and
disorganized by disease. In the other the symp
yet after death the posterior columns were found
toms were the same, and upon dissection Dr. Todd
Mr. Shaw considered that in the examination of
found the posterior columns destroyed by softening.
this question sufficient attention had not been paid
to the exact mode in which the anterior and pos-
terior roots came off from the spinal marrow, or to
paring the origin of the fifth cerebral nerve
the assistance which may be obtained by com-
with that of the spinal nerve. In regard to
the first point, the anterior roots in the spinal
nerves arise by numerous fine radicles from the
showing that the part of the cord from which they
very surface of the anterior column, thus apparently
derive the power of motion is situated superficially.
The posterior roots, on the contrary, dip bodily into
the interspaces between the posterior lateral and
posterior columns, and they reach a deep part of
the organ before they subdivide to form any per-
ceptible connection with the cord; in that the
mode of origin of the posterior roots is quite differ-

LONDON.-Nov. 19.

Dr. RAYNER, Vice-President, in the chair. Mr. Henry H. Salter, in accordance with the

rules of the society, read some selections from his paper on "The nature and causes of the various deposits that are formed within or upon the valves of the Heart, and the symptoms which indicate the existence of such morbid alterations"; for which the "Dean's Prize" was awarded at the close of

the last session. He enumerated six kinds of Valvular deposits:-1. Fatty degeneration; 2. Cartilaginous; 3. Osseous; 4. Warty vegetations; 5. Melanosis; 6. Strumous tubercle: to each of which found that the cartilaginous deposit, which occurs a separate section of his paper was devoted. He in the arteries and in the cardiac valves, presents frequently an evident fibrous structure, and is always destitute of the ordinary cartilage cells; and that the osseous deposit is deficient of the Haversian canals, lacunæ, and canaliculi of true

bone, or any structure analogous to them. His paper, illustrated with numerous most accurate and highly-wrought drawings, is placed in the library of the society.

Mr. Pittard stated that, having spent a good deal of time in investigating the diseases of the bloodservations as to the absence of true osseous strucves els, he was able to corroborate Mr. Salter's obture in the earthy deposits which occur in the arteries, and of cartilage cells in the so-called cartilaginous formations; he had not, however, observed, most probably he had overlooked, the fibrous structure of the latter. He had found reason to believe that there are two very different kinds of earthy deposits in the arteries: one is found in connection with fatty and cheesy deposit, very friable, and affects a rounded or nodulated of which it is, no doubt, an ulterior condition, is form; the other occurs unconnected with any other deposit, is more compact and strong in consistence, and assumes the form of scales. The latter he had always found accompanied by aneurisms, the former only occasionally so. But the most singular fact in the structure of the latter is, that there is a very small hole in the centre of each scale, around which