CRITICAL DIGEST OF BRITISH AND FOREIGN MEDICAL JOURNALS.

[The Articles quoted or abridged are indicated by an asterisk.]

LANCET.

MAY, JUNE, JULY, AND AUGUST.

1. IMPORTANT POINTS IN SURGERY. By G. J. GUTHRIE, Esq., F.R.S. May 1, June 12, July 17, August 7 and 28.

2.* CASE OF HIRSUTE GROWTH IN A FEMALE.

May 1, 29, July 17.

By W. D. CHOWNE, M.D.

3. CASE OF DISPLACEMENT OF BOTH HUMERI. By H. GREENWOOD, Esq. May 1.

4. ON APOPLEXY AND EPILEPSY, AND ON AN HOSPITAL FOR EPILEPTICS. (Croonian Lectures, 1852.) By MARSHALL HALL, M.D., F.R.S. May 8, 15. (Conclusion.)

5. ON REINSCH'S PROCESS FOR THE DETECTION OF ARSENIC. BY HARRY RAINY, M.D. May 8, (Conclusion.)

6. CASE OF VARIOLA CONTEMPORANEOUS WITH VACCINIA, both modified. By ROBERT FOWLER, M.D. May 8.

7. OPERATIONS FOR THE REMOVAL OF CANCER.

[Clinical Lecture.] By

JOHN SIMON, Esq., F.R.S. May 15, 22, 29. 8.*DISEASE OF THE GLANDS OF THE NECK IN CHILDREN. [Clinical Lecture.] By TYLER SMITH, M.D. May 15.

9. ON EXCISION OF THE HEAD OF THE THIGH-BONE. By G. J. GUTHRIE, Esq., F.R.S. May 15.

10. ON THE DETECTION AND PRESERVATION OF CRYSTALLINE DEPOSITS OF URIC ACID, URATE OF AMMONIA, AND OTHER URINARY SALTS. By A. H. HASSALL, M.D. May 15.

11. USE OF GLYCERINE IN THE TREATMENT OF CERTAIN FORMS OF Deafness. By THOMAS WAKLEY, Esq. May 15.

12. CASE OF CANCER OF THE STOMACH. BY MARRIS WILSON, M.D. May 15. 13. REMARKABLE FORM OF BULLOUS DISEASE IN NEW-BORN INFANTS AND CHILDREN. By ROBERT BARNES, M.D. May 15 and 22.

14. CASES OF ARRESTED PULMONARY PHTHISIS. [From Out-patient Department of Brompton Hospital.] By RICHARD QUAIN, M.D. May 22, June 12.

15. CASE OF CONTRACTION OF THE STOMACH. BY THOMAS DALE, Esq. May 22. 16. FRACTURED RIBS CONNECTED WITH EMPHYSEMA. [Clinical Lecture.] By JOHN HILTON, Esq., F.R.S. May 29.

17. CASE OF PUERPERAL CONVULSIONS FROM CEREBRAL CONGESTION, treated by Bleeding and Tartarised Antimony. By J. B. MAWER, Esq. May 29.

18. SINGULAR CASE OF ASPHYXIA. By G. P. MAY, M.D. May 29. 19. LECTURES ON LITHOTOMY AND LITHOTRITY. BY WILLIAM COULSON, Esq. June 5, 12; July 3, 10, 24, 31; August 14, 21.

20. SYPHILITIC IRITIS IN INFANTS. BY JAMES DIXON, Esq. June 5. 21. Ovarian Dropsy treated BY PRESSURE. By I. B. BROWN, Esq. June 5, July 31.

22. POLICY AND PATHOLOGY OF INSANITY. By JOSHUA BURGESS, M.D. June 5. (Continuation.)

23. PSYCHOLOGICAL CHARACTER OF THE PHYSICIAN. [Lettsomian Lectures.] By FORBES WINSLOW, M.D. June 12, 19, 26.

24.*CLINICAL ILLUSTRATIONS OF SUBACUTE OVARITIS. By E. J. TILT, M.D. June 12, July 17, August 14.

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25. IMPORTANT POINTS IN THE CHEMISTRY AND PATHOLOGY OF THE Urine. By A. H. HASSALL, M.D. June 12, 19.

26. STRICTURE OF THE URETHRA AND PERINEAL SECTION. [Clinical Lecture.] By WILLIAM COULSON, Esq. June 19.

27. CASES OF HERNIA. BY BRANSBY B. COOPER, Esq., F.R.S. June 19, August 7.

28. CASES OF EMPYEMA. By C. J. B. ALDIS, M.D.

June 26.

29. INTERESTING CASE OF GUNSHOT WOUND. By H. P. LAURENCE, Esq. June 26.

30. SIMULTANEOUS DISLOCATION OF THE HUMERI. By G. Y. Hunter, Esq. June 26.

31. MALFORMATION OF THE GENITAL ORGANS AND BLADDER. By B. DULLEY, Esq. June 26.

32. IMPORTANT POINTS IN MIDWIFERY. By J. POWER, M.D. July 3, 18, 24, 31; August 14.

33. CHLOROFORM INJECTIONS IN GONORRHEA. By H. BEHREND, Esq. July 3. 34. CASE OF GONORRHEAL OPHTHALMIA. [Clinical Lecture.] By JOHN ADAMS, Esq. July 10.

35. ILLUSTRATIONS OF SUCCESSFUL TREATMENT OF CLEFT PALATE. BY JOHN AVERY, Esq. July 10.

36. POISONING BY STRYCHNIA: RECOVERY.

July 10.

By J. C. FORSTER, M.B.

37. CASE OF VACCINIA AND VARIOLA. By G. H. HOPKINS, Esq. July 17. 38. EFFECTS OF LEAD UPON THE SYSTEM. [Lumleian Lectures.] By JAMES ALDERSON, M.D., F.R.S. July 24, 31, August 21.

39. TWO CASES OF OVARIAN ABSCESS, WITH REMARKS. By T. H. TANNER, M.D. July 24.

40. NEW METHOD OF TREATING DYSPEPSIA. By J. SPURGIN, M.D. July 24. 41. CASE OF RUPTURE OF JEJUNUM, CAUSED BY A KICK FROM A HORSE: PERITONITIS: DEATH IN THIRTY-SIX HOURS. By M. J. M'CORMACK, M.B. July 24.

42. CAMPHOR, AN ANTIDOTE TO STRYCHNINE. By J. PIDDUCK, M.D. July 24. 43. CASE OF VACCINIA AND VARIOLA IN AN INFANT. By T. C. BEATTY, Esq. July 24.

44. CASE OF TUMOUR OBLITERATING THE VENA CAVA. By W. J. Cox, Esq. July 31.

45. CASE OF CATALEPSY, ILLUSTRATING NEW PRINCIPLES OF TREATMENT IN CONVULSIVE AND SPASMODIC DISEASES. By C. B. RADCLIFFE, M.D. July 31.

46. INJURIES AND DISEASES OF THE JOINTS, [Clinical Lectures.] BY SAMUEL SOLLY, Esq., F.R.S. August 7 and 14. (Conclusion.)

47. CASES OF FISSURE OF ANUS AND ULCER OF LOWER PART OF RECTUM. By T. J. ASHTON, Esq. August 7.

48.*CASE OF BOTHRIOCEPHALUS LATUS OCCURRING IN AN ENgLish Child, cured by Oil of Male Fern. By W. W. GULL, M.D. August 14. 49.*ON CARBUNCLES AND BOILS, with reference to their prevalence as an Epidemic. By THOMAS HUNT, Esq. August 14 and 28.

50. TRIPLE PHOSPHATE IN URINE AND OTHER ANIMAL LIQUIDS. By J. W. GRIFFITH, M.D. August 14.

51. CASES OF STONE IN THE BLADDER. [Clinical Lecture.] By JOHN HILTON, Esq.. F.R.S. August 21.

52. CASE OF DISEASE OF AORTA, AND HYPERTROPHY OF LEFT VENTRICLE. By JOHN TOPHAM, M.D. August 21.

53. REMOVAL OF A CARIOUS OS CALCIS. By A. G. FIELD, Esq. August 21. 54. CONTRIBUTION TO CLINICAL MIDWIFERY. By N. J. HIGHMORE, M.D. August 21.

55. CASE OF DEATH FROM FIBRINOUS CONCRETION IN HEART. BY WALTER GARSTANG, M.D. August 28.

56. CASE OF RUPTURE OF PERITONEAL COAT OF UTERUS. BY RICHARD LEE, Esq. August 28.

57. CASE OF PHLEGMASIA DOLENS OF UPPER EXTREMITY AFTER PARTURITION. By J. M. WINN, M.D. August 28.

REMARKABLE CASE OF HIRSUTE GROWTH IN A FEMALE.
BY W. D. CHOWNE, M.D.

The history of the case, and comments thereon, were delivered by DR. CHOWNE to the students of Charing Cross Hospital.

in

CASE. "The woman, J. B., is twenty years of age, a native of VSwitzerland, and by occupation a needlewoman. She states, that at her birth she had, as she has been informed by her parents, a beard-that is to say, a considerable quantity of hair growing on those parts of the face usually occupied by the beard and the whiskers in men, except on the upper lip, and on the hollow immediately under the lower lip. It was at her birth, she states, about as long and as thickly spread as it usually is on a man's arm; in other respects she was not different from other female children. The beard grew gradually, and when she had attained the eighth year of her age it was two inches long. At about eighteen years of age, catamenial functions commenced, and have continued perfectly normal. She has had, and still has, very good health. Her occupations and dispositions are all womanly.

"THE HIRSUTE GROWTHS. At the present time, the beard and whiskers are what would be called very abundant, full, and strong, exceeding in quantity even that of the beard and whiskers of men generally in this country. It grows also on the parts covering the cheek-bones, under the eyes. Those parts of her face which were without beard at her birth, are still without. The hair forming the whiskers varies in length from one to four inches; that of the beard is about the same length. It is all strong, and rather coarse, as well as being very thickly set. She states that it does not require cutting. When she appears in public, she has a handkerchief folded three-cornerwise on her head, put on so that two of the corners pass down over the sides of her face, and meet just below the mouth, thus concealing the peculiarity. As the handkerchief cannot be worn so as to conceal that part of the face over the cheek-bone, (as it would then cover the eyes also), she shaves that part. In her own village, where she was well known, she had no occasion for the handkerchief, but in a strange place she finds it necessary, lest the police should regard her as a man disguised in woman's apparel.

"The hair growing from the crown and back part of the head is two feet and a half long, and that growing from the front part of the head two feet. Both the front and back hair is moderately abundant, not excessively so. It is neither fine nor coarse; the colour dark brown; that of the whiskers and beard the same.

"On the neck, and on the parts just below the clavicles, are numerous hairs thinly spread; much coarser and longer than the hair generally visible there in men. On the shoulders, arms, and fore-arms, to the wrists, there is a quantity of hair, about equal to what would be found in a man moderately hirsute, but more uniformly spread over the whole circumference of these limbs. The mammæ and the whole of the sternal portion of the chest are quite free from hair, indeed quite fair. The breasts large, fair, and strictly feminine in all respects, including papillæ and areolæ. On the back part of the shoulders there is also a good deal, and a tolerably broad line of dark hair extends down the back, sufficiently abundant to give quite a dark appearance in the line or depression over the vertebral column. The nates and the parts covering the tuberosities of the ischia, all have hair pretty uniformly spread, and in quantity about as much as would be on the limbs of a more than commonly hairy man. The anterior surface of the abdomen,

extending from the umbilicus to the pubal and inguinal regions, has the masculine quantity and the masculine distribution. The surfaces of the inferior extremities, to the ankles, are in the same state, excepting only the knees and hams, which are in the more ordinary state.

"GENERAL FORM AND VOICE. She is of short stature. The form of the head is not remarkable. The upper part of her thorax and the pelvis are feminine; her legs and knees less so. The feet small. The arms and the hands small and feminine. She has not any malformation of any kind. Dressed as a man, she would not have anything particular to betray her. Her manner, however, appears to be gentle, and would constitute a contrast to man's attire. Her voice, in conversation, is not remarkable either way. She sings occasionally, and then it is feminine.

"She states that, in her own country, it was deemed that there must be within the abdomen organs male in their character, both corresponding to the superfluous hirsute growth, and accounting for it. She was, at the time of my seeing her, about five months advanced in pregnancy. Besides the usual and less certain signs, the foetal cardiac sounds were audible.

"FAMILY, RELATIONS, ETC. She states that her mother's complexion was neither dark nor fair, but between the two. Her father was of dark (brown) complexion, and had not much beard or whiskers. Her mother's father was remarkable for having both whiskers and beard extremely large. She has one brother, man grown, who is, she states, almost entirely beardless; and two sisters not different from other young women. Her mother does not attribute the peculiarities to fright or other cause that she has any knowledge of.

"CO-EXISTENCE OF THE SECONDARY INDICATIONS OF SEX WITH MALFORMATION OF THE PRIMARY. In almost all instances where the general contour or aspect, or other secondary peculiarities, indicative of the sexes, are blended in the same individual, obvious specific malformation, or excess, or deficiency, or a combination of the primmary peculiarities of sex, has been found.

"In this case, however, there is a series almost complete of masculine indications or peculiarities of the general or secondary character, apparently in the entire absence of specific malformation, or excess, or deficiency, or combination, presenting an example to be classed amongst accidental growths of hair, rather than amongst such special growths as are the consequences of special physiological influences.

"With reference to the possible existence of a concealed organ or organs in the subject of these remarks, it is worthy of notice, that, although the superfluous growth is in some respects favourable to the supposition that such organs do exist, in other respects it does not favour that view. The beard, for example, existed at birth, and at eight years old was two inches long-thus anticipating the period of puberty, instead of accompanying or following it, and proceeding altogether in advance, and apparently independently, of special organic influence. The beard was, and still is, confined to certain parts of the face, and is absent on others, where, in accordance with special influence, in a male, it should have been present, as on the upper lip and under the lower. On the whole of the anterior part of the trunk above the umbilicus, where, in accordance with the same influence, it should be even specially abundant, it is wholly or very nearly wholly absent. These circumstances conspire to weaken the supposition that there are concealed male structures, and to strengthen the probability that the superfluity of hair belongs to the accidental class."

DISEASE OF THE GLANDS OF THE NECK IN CHILDREN.
BY TYLER SMITH, M.D.

DR. TYLER SMITH believes that, in many cases, the enlargement and suppuration of the cervical glands in children is due to local and removable causes, and does not depend upon any constitutional taint. He says:

"The lymphatic vessels take their risc, among other tissues, from the skin

and mucous membrane, but particularly from the latter. Different tracts of mucous membrane even have their different congeries of lymphatic vessels and glands, with which they are in intimate relation; as, for instance, the bronchial membrane and the bronchial glands, the urethra and the inguinal glands, the vagina and rectum, and the glands of the pelvis. In prolonged bronchial irritation, we get enlargement of the bronchial glands. In urethral inflammation, we have enlargement and suppuration of the inguinal glands; in irritation of the rectal and vaginal mucous surfaces, fistula or pelvic abscess from glandular inflammation and suppuration. Certain parts of the tegumentary surface are also in special relation with certain groups of glands; as, for instance, the skin of the upper extremity with the glands of the axilla, and the skin of the inferior extremity with the glands of the femoral region. It is quite unnecessary to do more than refer to the frequency with which injuries of the skin are followed by glandular suppuration in these situations.

"Now, I am convinced by careful observation, that the mucous membrane of the mouth, nares, and fauces, is in especial relation with the great number of glands and lymphatic vessels studding every part of the subcutaneous surface of the neck; and I am equally convinced that in the great majority of cases of enlarged cervical glands, the source of the disease exists in the neighbouring mucous membrane. Some irritation is present in the mucous surface, which affects the lymphatic vessels, and these propagate it to the glands, the glands inflame, pus is formed, the skin gives way, and the unhappy child is said to be the subject of a scrofulous sore. The scar is indelible, and ever afterwards the suspicion of scrofula is preserved.

"We see the influence of irritation of the mouth and fauces in producing enlargement of the cervical glands in its most marked degree, in scarlatinous and other forms of sore-throat. We see it also in the irritation of the mucous membrane in measles, dentition, salivation, aphthæ, carious teeth, canker, diseases of the gums, enlarged tonsils, common catarrh, a thickened state of the nostrils and Schneiderian membrane, thrush, and other affections to which this important division of the mucous membranes is subject. When there is a depraved state of the constitution, scrofula breaks out in different organs simultaneously; but when we see a local origin producing strictly local disturbance, and spreading only from point to point around the first disorder, I submit that we may fairly give the first place to local causes. In the end, no doubt, the persistence of local disorder may, and often does, produce the scrofulous constitution. The direction in which local disease of the lymphatics extends is generally from the surface of the body towards the thoracic duct, the centre of the lymphatic system; but this is not invariable; disease may travel down reversely from the lymphatics of the axilla or inguinal region to the knee or shoulder joints, but its extension in these directions takes place very slowly.

"It is in states of debility that inflammation of the lymphatic system most frequently occurs. In this, as in many other points, the lymphatics resemble the veins. The tendency to inflammation in the lymphatics may be produced by the very means taken to subdue inflammation in organs of higher vitality; it is frequently seen in its most marked form after bleeding and mercurialisation. In the chronic form, it travels so slowly, that its extension as a local malady is completely masked. Although the primary irritation is so frequently derived from the mucous surface, when a gland has once inflamed, it becomes a source of irritation to other glands in its vicinity, which in turn become inflamed, particularly if the primary gland suppurates. The following case is a good illustration of the local origin of glandular disease and its gradual spread along the lines of the lymphatic system.

"In consequence of a purely local irritation occurring in a young person of average health, one of the lateral cervical glands slowly became enlarged, and after several months suppurated. The sore thus produced excited,