proper enough in catarrh of the stomach, are here useless; and with a gargle, composed of a grain or two of corrosive sublimate in a pound of water, the author has several times cured in a few days a disease that had resisted the long train of antidyspeptic medication for months. Local sources of irritation, too, must be sought; for it has more than once happened to Dr. Pfeufer to relieve cases, by the removal of some sharp fragments of a tooth, which had been subjected to all the approved modes of treating gastricismus, and had resisted these, as well as long courses of mineral waters and the like! An acute form is also sometimes very obstinate, recurring again and again, and giving rise to loss of appetite. It is often very analogous to nasal catarrh, with which it is sometimes conjoined, and then the affection of the mucous membrane is primary. In other cases, however, and especially when produced by mental emotion, and when it is so often erroneously attributed to "bile," there is apparently a primary affection of the nerves of taste and sensation of the tongue, and then the catarrhal secretion is secondary. -Henle und Pfeufer's Zeitschrift, Band vii, 180.

Case of Obliterating Phlebitis of the Vena Porta. By M. MONNERET.

The patient, æt. 42, who formed the subject of this case had suffered, while residing in his youth at the Antilles, from yellow fever, dysentery, &c.; but his health of late years has been tolerably good, save occasional diarrhoea. On the 20th of September he brought up, without obvious cause, nearly a quart of black, coagulated blood, and suffered afterwards from bloody stools. His health gradually deteriorated; he became dropsical, and died 25th October; the superficial veins of the abdomen being in a varicose state. On examination, the liver was found to be so much atrophied as only to equal the two fists of the subject in size. It was of a uniform yellow colour, but not granular; only the principal branches of the vascular system of the organ were visible. The vena porta was much dilated in all its chief divisions, which were filled with a highly resistant coagulation, evidently formed long prior to death, being in some parts whitish, dry, and only removable by the aid of the scalpel. On examining the lining membrane of the vessel, to which it so firmly adhered, this was found to be rugous, deprived of its natural polish, thickened in some parts, and thinned in others. The middle coat of the vein, in its colour, consistence, and thickness, exactly resembled that of the aorta, presenting in several places the same yellow colour as a diseased artery. Glisson's capsule was hypertrophied, and of a whitish colour. The gall-bladder was small, white, and thickened, in some parts fibro-cartilaginous, and contained two calculi and a little bile. The choledochus was very narrow. The vena cava was free from obstruction. M. Fauconneau-Dufresne states that, as far as his investigations have gone, this is only the eighth case on record.-L'Union Médicale, 1849, No. 13.

On Angina Pharyngea. By M. VELPEAU.

THERE are distinctions in this disease, based on the different tissues affected, which it is important to bear in mind. In the first and more frequent variety, the free surface of the mucous membrane is inflamed, the inflammation spreading over the whole pharynx. In a second the inflammation occupies the tonsils and the mucous membrane in all its reduplications. The third variety is formed by the inflammation of the cellular tissue covering the external surface of the tonsils. In the first form the disease comes on suddenly, but rarely lasts long. It produces redness, but not swelling, and is frequently unattended with fever. It may be often arrested by local application, as alum; and if general treatment, such as bleeding, vomiting, or purging, is indicated, the disease is generally cured in two or three days. In the second form, alum would only exasperate the disease, and general means only slightly modify it. Left to itself, it may last from six to twelve days, often terminating by suppuration. Emetics are only useful in assisting the abscess in breaking. It is an affection of frequent occurrence, but is rarely dangerous even when both tonsils are much swollen.

The third form, cellular angina, is a more serious affection. A dull, permanent pain comes on, which at first, not extending to the inner side, does not interfere with deglutition. Owing, too, to the seat of the disease, the tonsil does not swell, but the whole of the affected side, tonsil, and soft palate, is raised by the swelling pushing up the various tissues. There is inflammation also of the corresponding cervical region, the parotidean and subhyoidean depressions becoming filled up with a red, tender, doughy tumefaction. This form of the disease may last from eight to thirty days, and terminate by any of the ordinary consequences of phlegmon. Leeches to the angle of the jaw, and other means of an antiphlogistic character, are indicated, and not unfrequently recourse is obliged to be had to the bistoury to prevent the injurious burrowing of matter; but the danger of wounding some of the important parts situated in this region often obliges us to hesitate. M. Velpeau alludes to a case in which he was about to open an abscess by incision into the pharynx, when, owing to the objections of the patient, he was induced to apply large flying blisters to the angle of the jaw, at the base of the inflamed part, and this was attended with the most complete success in dissipating the inflammation.-Gazette des Hópitaux, 1849, No. 12.

Epidemic of Rheumatism.

DR. HARTZ furnishes an account of a small epidemic of this disease, which prevailed at Kayserberg from the 1st of March to the 15th of April, during which time he was called to no less than 52 cases in a not very populous district. These were composed of 41 men and 11 women, from the ages of 17 to 38. With two or three exceptions, they were all persons enjoying generally good health, even of robust constitutions, and of sanguineous temperaments. In almost all, the attack came on suddenly, without apparent cause, or other than taking cold, usually assigned as the cause by the patients themselves. In a third part of the cases the disease simulated a pleuropneumonia, from which it was distinguished by auscultation.-Gazette des Hopitaux, No. 53.

SURGERY.

On Scapulalgia. By M. MALGAIGNE.

A SURVEYOR was attacked while employed in the country with a violent pain in the left shoulder, which continued very intense for forty-eight hours. Cupping and other means giving him very little relief; he came to the hospital supposing himself suffering from rheumatism. He kept his arm close to his side, and all attempts at moving it thence caused dreadful pain in the shoulder, where, however, there was little swelling and little tenderness, save at a circumscribed spot opposite the anterior part of the head of the humerus, where, on M. Malgaigne making pressure, the patient cried aloud. From this sign, together with the fact of no other joint being affected, M. Malgaigne declared that the case was not one of rheumatism but of scapulalgia, i. e. a simple arthralgia of the shoulder-joint. He ordered complete immobility of the parts to be secured by means of a clavicle-bandage, and for the first time for seventeen days the patient obtained sleep. At the end of ten days the bandage was removed, and the movements of the limb were found as painful and as difficult as before. He could only sleep by lying on the opposite side; and from the prolonged flexion, contraction of the biceps and rigidity of the elbow had been produced. M. Malgaigne sought for the tender point which had served him as an indication of the inflammatory stage of the scapulalgia; but repeated pressure against the anterior portion of the head of the humerus now giving no pain whatever, M. Malgaigne concluded that all that which remained depended upon the retraction of the ligamentous tissues. As is his practice in all cases of noninflammatory articular rigidity, he forcibly extended the arm, notwithstanding the

cries of the patient, until the biceps and the articular ligaments were thoroughly stretched, and rotation and abduction were freely practised. No sooner had the pain which this procedure caused disappeared, than the patient could move his arm without any suffering whatever-all his other pains being, in fact, dissipated as if by enchantment-some paralysis of the deltoid, from so long inaction, alone remaining. In cases more promptly treated, even a temporary paralysis of this kind does not take place; but if, after the inflammatory symptoms are removed by antiphlogistics and absolute rest, the effects dependent upon retraction are not forcibly overcome, atrophy and anchylosis are the results. In all the other joints there are also special points at which pain may be produced by pressure as long as inflammatory action is present, as behind the great trochanter in the hip-joint, at the head of the radius for the elbow. It is true there is pain also beyond these points, but this is comparatively of little importance. As long as this tender spot is present absolute rest must be continued, but as soon as it has disappeared, we may be certain the morbid element consists in mere retraction, and should waste no time with baths, pomades, and the various revulsives, because pain yet continues diffused around, or is produced on motion. The patient's courage must be appealed to, and without further delay we must, with the requisite firmness, thoroughly elongate the retracted tissues. In this way alone can anchylosis and its consequences be prevented, especially when the hip-joint is the one in question. During ten years M. Malgaigne has never found this valuable criterion in arthralgia and white-swelling fail him.-Revue Médico-Chirurgicale, t. v, pp. 177-80.

She

Since the publication of the above paper, another illustrative case has been published. It occurred in the person of a woman, æt. 26, of good general health. About two years since, she was seized without apparent cause with a pain in the shoulder, which, after a while, rendered all movement of the arm impossible. was long treated in vain by various local applications, and then for some months in an hospital as for rheumatism. From the physician's wards she was transferred to one of those of M. Malgaigne, and on her admission she could not move her elbow from her side, or in the least degree extend her arm, the slightest movement of her shoulder also producing great pain. This case M. Malgaigne recognised as an example of scapulalgia advanced to a certain degree of anchylosis, perhaps even to complete anchylosis; and he confines his attention in treating it to purely mechanical measures, the case being, in fact, still in progress of treatment. Every day he induces some degree of abduction of the arm, and obliges the patient to hold it away from the trunk, by placing the point of a pin beneath it, which pricks the arm whenever it is lowered. By this simple contrivance a considerable improvement has been already secured.-Gazette des Hópitaux, No. 61.

On Traumatic Cataract. By M. TAVIGNOT.

To what extent does a cataract produced by a traumatic cause comport itself differently from one occurring spontaneously? In the first place, the spontaneous one is oftenest lenticular, the traumatic one capsular or capsulo-lenticular. Traumatic cataracts are almost always more or less soft, while a considerable proportion of the spontaneous ones are hard or hardish. Moreover, in spontaneous cataract there is not usually any accompanying inflammation of the eye or its appendages, which is necessarily present in the traumatic form. Such inflammation may give rise to adhesions between the iris and the anterior crystalloid, or to a painful condition of the ciliary nerves, which is always more or less reflected on to the retina, producing in the course of time either an enfeebled or amaurotic state of it. Sufficient attention has not been paid to the effect of the inflammation on the cataract itself. As long as inflammation continues, the opacity either increases or remains stationary, inflammation and absorption being two incompatible phenomena. Traumatic cataract is usually found but in one eye, while in spontaneous, both eyes are generally successively or simultaneously affected. Although it is contrary to M. Tavignot's experience, that a traumatic cataract in the one eye can give rise to a

spontaneous one in the other, yet he is far from denying the reciprocal influence of the two eyes, though not demonstrated to that extent. Of its existence, however, we have a proof in the reflection of the inflammatory action occurring in traumatic cataract to the opposite eye, giving rise to sympathetic iritis; and, as M. Petit observes, even cataract may be produced in the sound eye, not, however, because such exists in the injured one, but from the amount of sympathetic inflammation set up in the former. A last point of difference is, that while the spontaneous cataract, in process of formation, is always, though in a variable time, tending to become complete, the traumatic one, produced and maintained by inflammation, has no tendency when that inflammation subsides to make further progress. This is especially the case with regard to the anterior capsule, which may remain for the rest of life partially opaque, partially transparent.

The traumatic lesion may operate either by producing mere contusion or by opening the capsule to a greater or less extent. The most constant result of a contusion of the eyeball is an effusion of blood into the chambers of the eye, which at first prevents our ascertaining the exact amount of injury. But in giving a prognosis concerning the visible lesions, we must never forget that the globe has been subjected to a true concussion, the result of which may be a paralysed state of the retina, with or without a dilated condition of the pupil. The various other structures of the eye may also be more or less dangerously injured, and the lens becomes opaque, as a consequence of its relations with the neighbouring parts now acutely inflamed. The primary traumatic cataract may in some cases be a very simple one, all the inflammatory disorders being limited to the crystalline apparatus, and inducing very little general reaction; but the consecutive traumatic cataract is always accompanied by numerous disordered conditions of the interior of the eye, it being itself one of the complications of these different morbid elements.

Traumatic cataract from solution of continuity in the capsule may be best practically considered under three different heads :

1st. There may be a mere prick or slight wound of the anterior capsule. It is easily repaired; but a more or less well-defined opaline opacity remains, being sometimes quite circumscribed, and at others gradually diffused over the capsule, rendering it unfit for vision. In the case of this diffused opacity we seldom fail to observe, during the first three days, that the lens becomes in some degree displaced forwards, so as even to push the iris forwards into the anterior chamber. The pressure renders the iris convex, more or less dilated, and almost immoveable. In fact, the crystalline has not moved; but under the influence of the inflammation of the crystalloid, an intra-capsular dropsy, projecting the anterior capsule forwards, has occurred. At this period, so great is the opacity, that vision is abolished; but yet has the lens thus far preserved its transparency, and it only loses it by prolonged contact with the newly-formed fluid.

2d. The capsule has become opened to an appreciable extent, and irregularly, one of the lips of the wound projecting forwards, being free, or adherent to the pupillary margin, which is itself either intact or divided. When a wound of the capsule remains thus gaping, without tendency to cicatrize, the torn membrane becomes rapidly opaque, its lips curl upon themselves, and either remain free and floating, or contract adhesions with the surrounding parts, the result in all cases being rather to enlarge than diminish the size of the aperture. Does the crystalline, thus placed in these entirely new conditions, and in contact with the aqueous humour, escape destruction? In some cases, in the author's opinion, it preserves its normal vitality after the destruction or loss of its capsule. Various surgeons have observed it retaining its transparency after being deprived of its capsule, whether continuing in its normal position or thrown into the anterior chamber. As long as it retains its transparency it will not disappear by absorption; but once become opaque, it softens, and is absorbed in a variable period. In the majority of cases, an exposed lens sooner or later becomes opaque, takes on a milky-white appearance, then softens, and disappears. Its resorption may be effected in two modes. It may remain in situ, inclosed in the wounded capsule, and then the absorption takes

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place very slowly; or the opaque body becomes divided into fragments, which successively separate, and fall through the aperture of the capsule into the anterior chamber, and are rapidly absorbed. The capsule, however, remains, and may be an obstacle to vision, though not an absolute one, owing to the aperture in it made by the wound. Moreover, it is not uncommon to find this accidental opening gradually enlarge, so as to acquire the diameter of the pupil itself-a complete cure being thus effected.

3d. The capsule has been largely opened, and the lens has passed more or less forwards, towards or into the anterior chamber. This amount of injury is in general effected by contusing bodies, and the lens is not here, as in the last case, displaced because its capsule is torn; but by reason of the violence of the injury, it tears the capsule itself. Sometimes the aperture is insufficient, and the lens, as it were, remains strangulated. The lens may be luxated either forwards or backwards, and in the former case it is occasionally retained by a too narrow pupil (which, however, it usually passes easily), and then may give rise to a dangerous iritis. Arrived in the anterior chamber, it sometimes gives rise to very acute inflammation, and at others to a mere slight reaction. In the first case it rapidly becomes opaque, and in the other retains its transparency.

In the progress of a traumatic cataract we should distinguish between the period of development and that of resolution. The first is of short duration, opacity soon occurring; but the latter is generally delayed by the persisting inflammatory action, which must first be dispersed; and in several cases, no spontaneous cure occurring, the cataract continues indefinitely.

The prognosis in this cataract is unfavorable, as compared with that of the spontaneous, and this in proportion to the persistence of the inflammation. Mackenzie is the only author who has indicated the pathological circumstances which render the spontaneous cure of these cataracts possible. This depends upon whether the capsule is lacerated or not. If it continues perviously open, we may leave the case to nature, favouring absorption by appropriate means, and removing complications. If the capsule is intact, or the wound has united, we must, by the removal of present inflammation, prepare the patient for future operation.-Gazette des Hôpitaux, Nos. 14, 26.

On a Case of Blenorrhagia occurring in a Perforated Urethra. By M. RICORD. A MAN, æt. 24, entered the hospital, who, when seven years old, had fastened a packthread around his urethra, and given rise to the production of mortification, the consequence of which has been to leave a circular constriction where the anterior two thirds of the organ joins the posterior third. Both anterior and posterior to this constriction, is an aperture, into which an instrument can be passed, all urine passing out at the posterior one. Erections take place as in the normal condition, and a month prior to admission, the patient had contracted a blenorrhagia, which as yet had not been subjected to any treatment. The discharge, which was abundant, occupied both portions of the canal. On the 3d of February, copaiba was prescribed internally, care being taken that none of the urine should come in contact with the anterior portion of the canal; and by the 8th, all discharge from the posterior portion, along which the urine flowed, had disappeared. The patient was now directed to allow the urine to traverse the anterior portion, which had as yet undergone no change in the amount of discharge, and in a very few days the disease became cured in this as well as the other portion.

This case, and others similar to it, which M. Ricord has recorded, prove, he observes, that the specific action of cubebs and copaiba do not depend upon any revulsive action or modification of the condition of the blood, but upon their direct and local action upon the diseased parts with which they are brought into contact by means of the urine containing them. The urine impresses some modification upon these substances, which is not imitable by art; for in whatever way we introduce cubebs or copaiba as injections, they not only do not act beneficially, but may do injury.L'Union Médicale, No. 46.