refused to allow premature labour to be induced in her second pregnancy; and we must confess that we think in the cases of individuals who, aware of their unfortunate conformation, allow themselves to become pregnant, and yet refuse their offspring the chance of life which the induction of premature labour gives, the obstetrician is not morally justified in preferring embryotomy to the Cæsarean operation. The fourth case occurred in an intelligent primipara, æt. 25, and although the deformity was such, that extraction of the child by embryotomy was barely possible, yet the practitioners in attendance, only called to her after sixteen hours of violent labour, during which convulsions had occurred, and encouraged by the repeated demands of the patient, preferred the performance of the Cæsarean section. A small asphyxiated child was removed, and soon restored to life, and the mother did very well. Thus within the space of five years, the Cæsarean operation was performed three times in one provincial district of France with success, though its results have been found as fatal in the capital as they have hitherto in our own country. That such success is in great measure due to the purer medium in which the patients lived, there can be little doubt; although M. Capuron seems to think otherwise, as he terminates his report by an indirect preference of the section, even to the induction of premature labour. He says, "Who would dare, under this pretext, to refuse the hand of succour to women in large towns, having excessively deformed pelves, and expose them to the chances of an artificial delivery at the end of seven months, to prevent the danger, or even death, that awaits them at the ninth, for want of good air ?"-Bulletin de l'Académie, t. xiv, pp. 775-85.

On the Pneumonia of Children. By M. VALLEIX.

CONTRARY to formerly entertained opinions, pneumonia is a frequent disease in children; but it is to speak too vaguely to treat of children in the mass, as great differences exist, according to their ages. We may take three periods into account: 1st, from birth to the second year; 2d, from two to six; and 3d, from six to fifteen. And as a general statement, making allowance for even numerous exceptions, it may be said that the disease decreases in severity from the first to the third of these periods. Careful researches have proved that during the first two years pneumonia is more frequent, more dangerous, more rapid, and oftener double, than at any other period of life except extreme old age; and the similarity of the disease, at these two extreme periods of life, is in many respects very remarkable. During even the first period, the danger of pneumonia much depends upon the part of such period it occurs at. Whatever the state of the child's health may be, if attacked during the first month it may be regarded as doomed to certain death; and from the first to the sixth month there is little hope of saving it, if the attack be at all severe. From the sixth to the twenty-fourth month the cures become more frequent, but the prognosis is still very bad, and should be most guarded, until convalescence is quite complete. The general symptoms may seem to amend, and the local ones to make little progress, but in from twenty-four to thirty-six hours a recrudescence occurs, which proves rapidly fatal. If the patient continue uninterruptedly to improve during thirty-eight hours, the convalescence is almost always definitive. The local symptoms should be especially watched; for it is not here as in adults, in whom we often see local symptoms continue for a considerable time after the general ones have diminished, without any cause for alarm. If in the infant there is not in twelve hours a notable improvement in the local symptoms, a fatal relapse must be feared. Another peculiarity is the lobular form of the disease, usually a consequence of an already severe attack of capillary bronchitis. At this period, too, as in advanced age, double pneumonia and pneumonia of the apex are common. M. Valleix believes that there is some confusion in the statement of MM. Bailly and Legendre, that the anatomical condition of the lungs in these cases is due to a persistence of the fœtal state; for although a condensed state of the pulmonary tissue, disappearing on insufflation, may very often be found in very young infants, yet it is an error to suppose that all the cases usually described as infantile pneumonia are of this nature.

He has, in such cases, met with even a denser hepatization than in the adult, the lung rapidly sinking in water, and being quite impervious to insufflation. The cases described by these writers would not, from their symptoms during life, be considered by good observers as pneumonia.

In proportion as we approach the second period, the pneumonia loses its lobular character, and approaches nearer to that of the adult, while its fatality diminishes also. Indeed, especially during the last two or three years of this period, the benignity of the discase is remarkable; and little alarm need be excited, except if the child is already an invalid, when the supervention of pneumonia is exceedingly dangerous. By benignity it is not meant that the symptoms are slight, but that the cure is so sure; for, in fact, the symptoms have a very alarming appearance, and yet, in spite of them, amendment takes place in from two to four days, after which time the cure goes on rapidly.

In the third period, the disease still more resembles that of the adult, and is still benign. A distinguishing circumstance at some part of this period is the appearance of expectoration.

As a general rule, the younger the child the greater is the difficulty of the diagnosis. For auscultation, very young children should be held, by an assistant placing his hands under the thorax and belly, when examination can be made, especially as in this position the child usually ceases crying for awhile. Older children should be held on the mother's arm. In a case, in which auscultation was very difficult, M. Valleix availed himself with success of the observation of the increased thoracic vibration, indicated by Monneret.

Treatment. During the third period, the child is treated as the adult. In the second, we must be more chary of our means, remembering that there is a natural tendency to cure. One bleeding usually suffices, and antimony should be reserved for only severe cases, and used with great caution. With still greater caution should it be given in the first period. Still if there is great or increasing hepatization, it is to be used in divided and infrequent doses. Small cuppings are very preferable to leeching, and mild opiates are too much dreaded by practitioners. Blisters should be wholly discountenanced, especially in the very young.-Bulletin de Thérapeutique, vol. xxxvi, pp. 97-103.

Masturbation in Girls. By M. RENE-VANOYE.

DR. DURR long since affirmed that this may always be suspected when warts are observed on the index or medius finger, especially when they are not present on the other fingers. In support of this opinion, Kretschmar gives the case of a girl, who, wishing to ascertain whether her fowls were about to lay, was in the habit of passing her finger into the cloaca, with the effect of generating an abundant crop of warts upon it. Dr. René-Vanoye has recently met with two cases, in which this sign enabled him to discover the real cause of otherwise inexplicable exhaustion. It is one certainly desirable to bear in mind, though cautiously to be made use of.—Rev. Méd.-Chir., t. v, p. 235.

On Local Bleeding in Displacement of the Uterus. By M. OLLIVIER.

M. C. OLLIVIER, of Angers, observes, that during a fifteen years' practice, in which uterine diseases have especially occupied his attention, he has never met with a case of displacement of the uterus that was not preceded by a more or less considerable degree of engorgement; and that instead of employing pessaries, and the whole variety of palliative bandages, he has been always enabled, by leeching the os uteri, to effect a radical cure. The careless way in which lecching this part has frequently been performed, has been the reason it has so fallen out of favour. In the first place, it should very rarely be undertaken, except in chronic uterine affections, when the congestion has become purely passive. Small lecches should

be employed rather than large ones, the suction of the latter being too energetic, and their bites sometimes proving painful. They should never be employed in a large number, it being far preferable to renew their application frequently. In applying them, a small conical speculum should be used, so that the whole of the os uteri may not become inclosed within it; for otherwise there is risk of the leeches entering within the cavity of the cervix. It is from accidents, which have resulted from their doing so, that their application has been thought to be attended with danger. It is evident that considerable engorgements will yield only to repeated applications; but these should be made by a small number of small leeches.-Gazette des Hopitaux, No. 103.

Recovery of an Infant after Perforation of its Cranium. By Dr. LAGAE.

IN July, 1839, the author was called to a woman, æt. 34, in labour with her second child. Two years before, she had been delivered of a still-born child by means of the forceps. He found that the labour had continued more than forty-eight hours, and that the practitioner already in attendance, after having in vain endeavoured to deliver by the forceps, had perforated the cranium, and made ineffectual efforts at extraction. The woman was fatigued, but not exhausted; and Dr. Lagae fearing, owing to the height at which the head was situated, and to the narrowness and obliquity of the pelvis, that greater danger would result to the mother by continuing the attempts at extraction than by performing the Cæsarean section, resorted to the latter. No difficulty attended its performance, the mother getting about in a few weeks, and living for eight years after. A feeble male infant, heaving some sighs, was delivered. There was a large wound in its cranium, situated to the right of the sagittal suture, and a few lines in front of the posterior fontanelle. Through this the brain was visible, looking like a sanguinolent pulp, a small portion escaping by the wound, as did other portions, after the suppurative process was set up. The child recovered; compresses, dipped in cold water, being alone applied to the part. It, now nine years old, was recently exhibited to the West Flanders Medical Society, a loss of substance equal to a two-franc piece in size being still observable in its cranium, notwithstanding that reparation of the loss of the cranial bones occurs in the young.

The child's intellectual faculties are in their normal state. A circumstance worthy of note is, that at the solution of continuity in the bone, where the soft parts alone cover the brain, there sometimes takes place a depression, and then the brain is plainly seen raised up by the arterial pulsations at the bottom of this cuplike depression. When this appearance manifests itself, experience has shown that the child is not well. At other times, the soft parts remain on a level with the cranial bones, and the arterial pulsations are slightly, if at all, observable.-Revue MédicoChirurg., tom. vi, p. 55.

Vagitus Uterinus.

DR. WINKEL Communicates a case which occurred in the person of a rickety woman, in labour with her first child. He and several other persons distinctly heard the infant cry during a quarter of an hour, while still in its mother's womb. Indeed, it was only delivered eight or nine hours after by means of the forceps, and that with such difficulty that its life was sacrificed. The hydrostatic test, applied twenty-four hours after, showed that respiration had occurred.-Medecin. Zeitung, 1849, No. 12.

[It is to be regretted that so meagre an account of the phenomenon should have been given; for the mere fact of the child's head requiring to be brought by the forceps through a rickety pelvis several hours after, is no proof that its mouth may not have descended to some distance in the cavity before the cry was heard.]

MATERIA MEDICA AND THERAPEUTICS.

On Nux Vomica in Impotence and Spermatorrhea. By M. DUCLOS. INCOMPLETE impotence is of far more common occurrence than would be sup posed, until many patients have been questioned respecting it. Erections are almost always possible, especially in the morning; but they are soft, incomplete, and insufficient, a certain amount of tension only continuing, and that for a short time. This state may be met with in men even of the strongest make and most robust constitution, in whom the vascular and muscular systems have attained their highest development. In others, in whom these systems and the nervous system are illdeveloped, the generative functions are properly exercised; so that the general physical force is no criterion of the special force of these organs. This imperfect condition is as often found in those who have been excessively continent, as in those who have abused the sexual organs; and it is observed just as often in persons whose nervous system is easily excitable, as in those in whom its lesser irritability allows of a predominance of the muscular and vascular systems. Self-pollution may occur either by night or by day, the discharge being either a true or a pseudospermatorrhoea.

Accident first led the author to the employment of nux vomica in this class of affections; and he has since observed several cases in which its efficacy has proved very great. He divides 75 grains of the alcoholic extract into 100 pills. During 5 days he gives 1 every night; then for other 5 days, 1 morning 2 night; for other 5 days, 2 night and morning; and for other 5 days, 2 morning and 3 at night; and so on until 4 are taken night and morning. He has never found any harm result, although some patients have taken 14 pills per diem. In many cases the stomach is rapidly improved by the medicine, the lost appetite returning. The following liniment rubbed into the loins and on the inside of the thighs is a valuable though not an essential auxiliary:-R. Træ. Nuc. Vom., Træ. Arnica vel Melissæ, āā, 60 p. Tr. Lytte 15 p. The regimen should be tonic; and the increased appetite demands a larger supply of food. A very moderate use of coitus is advisable.— Bull. de Thérap. tom. xxxvi, pp. 529-33.

Creosote in Mercurial Salivation. By Dr. FAULCON,

DR. FAULCON relates a case of profuse mercurial salivation, in which, after the unsuccessful employment of the usual remedies, he employed with great advantage a gargle composed of creosote 3, sage tea a pint, the affection quickly yielding.Phil. Med. Ex., No. 47.

[Although this is but a solitary case, the remedies generally resorted to in salivation are so commonly altogether useless, that we have thought it right to quote it.]

On the Therapeutical Employment of Manganese. By M. HANNON.

THE author seems to have been led to the employment of manganese by the somewhat fanciful suggestion, that as metallic substances usually found together exhibit many analogous effects, it might be possible, owing to the almost constant natural union of iron and manganese, that in cases in which the former of these did not exbibit its usual medicinal efficacy, this might be due to the artificial separation of the two substances. However this may be, he has found experimentally that in chlorosis, anæmia, and other diseases in which ferruginous preparations are so useful, manganese is so likewise; and markedly so in those cases in which iron has already failed, or only succeeded partially. He has since learned that M. Millon, in his recent researches upon the human blood, has always found it to contain silex, manganese, lead, and copper. In simple anæmia, manganese acts even more rapidly than iron; and it has been found of considerable service in the anæmia resulting

from the cachexia of cancer, scrofula, syphilis, and ague; and that without the induction of the injurious stimulant effects often produced by iron when employed under these circumstances. In scrofula, iodide of manganese has proved very superior to iodide of potassium. Notwithstanding that the quantity of manganese required to exert a curative effect is much less than that of iron, the durability of such effect is much more considerable. Another very great advantage is, that it does not give rise to the numerous decompositions which iron does when united to other tonics. The preparations of this metal are powerfully astringent, and may be employed externally. M. Hannon gives a great variety of formulæ, and recommends that the more insoluble preparations (as the carbonate, phosphate, or oxide) should be commenced with, and then the more soluble, as the tartrate, malate, iodide, and chloride, may, if necessary, be resorted to. The substance being rapidly assimilated, none is found in the excretions, and it need not be so long continued as iron.Rev. Méd.-Chir. tom. v, p. 332.

On the Properties and Administration of Quinine. By Dr. HOLMES.

WHILE Some authors advocate the use of quinine as a sedative, others praise it as a stimulant, and the majority seem to regard it as possessing one or other of these properties, according to the dose in which it is given. Dr. Holmes considers that in large doses it acts as a sedative to the vascular, but as an excitant to the nervous system, producing a high degree of nervous erethism, a peculiar irritability of the nerves of hearing and vision, and a distressing vertigo. This tendency to affect the brain has led to the medicine being proscribed in fevers accompanied with cerebral congestion or inflammation, or nervous excitability; and investigation has led Dr. Holmes to the conclusion that digitaline modifies the action of quinine in this particular more than any other agent does; combined with this, he has given it in large doses to children of mobile and impressible temperaments with the best effect, and the same with regard to delicate females, who before could not tolerate the drug at all.

He regards quinine as possessed of high antiseptic properties; and states that in malignant and protracted fevers, in which it may be thought desirable to make an impression with mercury on the system, it expedites the effect of calomel upon the mouth, and yet checks its tendency to induce ulceration of the gums or sloughing of the cheeks. In typhus or typhoid fevers it checks the tendency to putrescency. Its abundant employment is the sheet-anchor which rarely fails the practitioner in the American remittent fevers. Its great power as a febrifuge has led to the overlooking, in some measure, of its beneficial agency in long-standing neuropathic affections.-Philadelphia Med. Examiner, No. 48, p. 764.

On Valerian in Epilepsy. By M. CHAUFFARD.

M. CHAUFFARD, an able practitioner at Avignon, adds his testimony to that of so many other writers, concerning the great efficacy of this substance in the various disorders of the nervous system; and in truth in many of the functional disturbances of this it is invaluable. M. Chauffard likewise confirms the opinions of many of the older and some of the modern writers on the materia medica, as to its utility in epilepsy, and he attributes the failures in very many cases in which it has been given to the small quantities employed. To be of use in this formidable affection, very large quantities must be perseveringly taken for some months. In the cases given in illustration, as much as from four to sixteen drachms of the powder were taken in divided doses, daily. Great repugnance is at first felt to both its taste and smell, but this is soon got over, and neither nausea, oppression, nor other disagrecable sensation results; nor does the drug with any certainty produce diuretic or other marked effect. Dr. Chauffard generally premised a bleeding with good effect; and several cases remained under observation for months and years after the cure was effected.-Rev.-Med. Chir. t. v, pp. 265-72.

[We are almost tired of chronicling remedies for epilepsy, so fallacious do they