in the other, the rubeolar eruption had predominated on the pulmonary mucous membrane, so as to produce an antagonistic fluxion, preventive or retardatory of, or diminishing, the cutaneous eruption. Such antagonistic fluxions may not unfrequently suffice to prevent all cutaneous eruption, and then we have eruptive fevers without eruption. In scarlatina it is to the mucous membrane of the pharynx and mouth that the critical phenomena are diverted.-L'Union Médicale, No. 54.

[We were lately in attendance upon a little boy, in whom the eruption of the skin and the angina were so slight, that we merely at first conjectured the possibility of scarlatina, although subsequent desquamation and the peculiar depression, such as is produced in some children by the presence of its poison in the blood, enabled us afterwards to be quite certain on this point. A brother of the above, aged 5, from being an active, lively lad, became a moping, dull one, suffering much from lassitude and anorexia. Repeated careful examination discovered not a trace of eruption or angina, and no suspicion of the possibility of scarlatina could have been excited but for the teaching of the other case. Nevertheless in a week or two's time, decided anasarca with albuminous urine manifested itself, requiring a long course of aperients, tonics, and baths for its removal.

On Blue Pus. By M. OLIOLI.

THE case furnishing the blue pus occurred in the person of a woman in one of M. Maisonneuve's Wards. She had formerly been operated on for a cancerous breast, and now returned with a reproduction of the disease. Canquoin's caustic was applied, and after the eschar fell off, the pus discharged was observed to be of a greenish-blue, and that whether medicinal applications were made to the part or not. M. Olioli had seen a similar case at Turin, when, after amputation, blue pus was produced, though only simple dressings were employed. M. Bouchardat analysing the pus in the present case, found in it an organic colouring matter of unknown nature, but no other principle capable of explaining the colour. Two cases are recorded in the Gazette Médicale' (1831 and 1834), in which the serum of a blister was coloured blue. MM. Persoz and Dumas conjectured that, in certain illconditioned suppurations, hydrocyanic acid might be generated, and subsequently a compound analogous to Prussian-blue formed; but subsequent chemical analyses give no support to this conjecture. In some researches which M. Comte made concerning the composition of this pus, he also found it containing a peculiar organic colouring matter.-Gazette des Hôpitaur, No. 47.

[In a well-marked case of the discharge of blue pus, recently occurring at Dublin, the analysis of Dr. Apjohn led him to believe that the colour very probably, though not certainly, depended on the presence of Prussian-blue.-See Dub. Med. Press, April 1849, p. 263.]

On Cephalamatoma. By M. CHASSAIGNAC.

M. CHASSAIGNAC believes that whatever operation is performed for the relief of this affection, it proves very hazardous to the infant, and he takes the occasion of a recently occurring case, which he watched closely during life, and examined after death (from other causes), for drawing attention to the remarkable activity of the absorbent power at this age, and to the mode in which Nature thus operates a spontaneous cure. The sanguineous effusion gradually becomes encysted, though for a few days the blood is in direct contact with the bone and periosteum; an organic membrane separated into two layers, and which afterwards takes on all the characters of periosteum, then surrounds it, and the absorption proceeds. In proportion as the quantity of effusion diminishes; the osseous rim or border which surrounds it also diminishes in diameter, by reason of a double simultaneous action, viz. resorption at its external circumference, and a concentrical reproduction at the inner one. Very voluminous tumours in this way disappear; and so great is his fear of exciting suppuration in them, that M. Chassignac strongly advises all interference to be withheld, save in the extremest cases.

M. Debout agrees with M. Chassaignac, that in the great majority of cases, absorption will take place during the first six weeks of life; but after this period sometimes a serous cyst is formed, containing a reddish fluid, very like that found in mammary cysts the results of contusions. This cyst generally inflames and suppurates, giving rise to necrosis and fever, which may be prevented by opening the cyst. This operation, however, may be followed by erysipelas, or the formation of abscess, and M. Trousseau's procedure offers the greatest security against these accidents. With a narrow bistoury, so held as to cut from within outwards, he makes a puncture at the lower part of the tumour, and endeavours by pressure to empty it of its entire contents, and then applies strips of diachylon and a bandage, so as entirely to exclude the access of air. In eight or ten days these are removed, and all is found to be doing well.-Bulletin de Thérapeutique, t. xxxv. pp. 448-55. Dr. Vogler, writing upon this subject, observes, that he is an example of how careful medical men should be in drawing general deductions from even a quarter of a century's experience. Thus, a very short time since he published a paper, in which he stated, that during this space of time he had never had occasion to open a cephalæmatoma, having always succeeded in dispersing the tumour by lotions of sal ammoniac, alcohol, and water, in from three to six weeks. Yet since then has he, in the course of only one year, met with three cases in which he felt called upon to open the tumour. In the first case, he did so because a severe ophthalmia in a child but a fortnight old forbad the use of wet applications. After the blood was discharged, suppuraton was set up, but led to no bad consequences. The second case occurred in a child half a year old; apparently as a result of contusion. The swelling had all the appearance of a deep-seated abscess, but on an incision being made pure blood flowed out. A somewhat tedious suppuration followed, but all did well. In a third case (æt. 15 days), the swelling was very tense, and as the parent neglected applying the lotion, the author opened the tumour and discharged the blood. Very insignificant suppuration followed.-Medicinische Zeitung, 1849, No. 13.

On Melana in Children. By M. RILLIET.

M. RILLIET, one of the authors of the classical work on the Diseases of Children,' takes the occasion of two cases of intestinal hemorrhage in children, which have come under his notice, to furnish a summary of what is known upon the subject. The cases he relates are unique, inasmuch as they are examples of this rare disease occurring in twins. The first child, though not large, was well formed, and had cried strongly after birth. The meconium had been discharged by castor-oil; the child had sucked, and seemed in all respects doing well, when several hours after birth it passed two or three stools wholly composed of blood, and became deathly pale and cold, and was unable to swallow. It cried, but there was no vomiting or convulsion. Cold compresses were applied to the abdomen, the warmth of the extremities being maintained; rhatany was employed both in injections and external applications, but the former being always returned with blood, the latter were alone continued. The child gradully rallied after six bloody stools had been passed. While this child yet continued in an alarming state, the other twin was seized with vomiting and purging of blood, and decoction of rhatany was in the same way applied to its belly. It recovered, though the bleeding continued more obstinate. Both children remained well, though long continuing exceedingly pale. Different authors have ascribed the affection to various causes, but an analysis of the published cases leads Dr. Rilliet to doubt the efficacy of most of those assigned, e. g. the condition of the health of the parents, the nature of the labour, the too early division of the funis, the weakness or plethoric state of the child, the presence of irritating matters in the intestines, external violence, or the rupture of vessels; and although the affection usually occurs at from the first to the fourth day, it has been met with as late as the sixth, eleventh, or twentieth, boys seeming

more liable to it than girls. Dr. Rahn-Escher, of Zurich, believes that much depends upon hereditary influence, a diseased state of the digestive organs being communicated from parent to child. This view would seem to be best supported in those cases where the parents also suffer from hemorrhages, or where several of their children do so simultaneously or successively. Billard states that the majority of fifteen children dying from it, were remarkable for plethora, but the experience of others does not bear out this view. Numerous pathological observers agree in stating that there is no important vascular lesion, the mucous membrane being sometimes not more injected than natural; others have found the abdominal veins gorged with blood, and the mucous membrane softened and reddened. The naturally injected state of the intestinal tube in the child may act as a predisposing cause when there is atony of its vessels, or obstruction to the abdominal circulation. The difficulty with which respiration is established at birth, especially if the lung is incompletely dilated, may exert an influence.

The bleeding in most cases has followed the meconium, but unpreceded by any premonitory symptom. It is usually abundant and frequent, rich in colour, and either fluid, or in part coagulated. Hæmatemesis, though more rare, may yet be abundant; and Etlinger gives a case in which a pound of blood was discharged by vomiting and stool. Sometimes the hæmatemesis is more abundant than the intestinal hemorrhage, but it is always accompanied by the latter. The hemorrhage may attain its maximum in twenty-four hours; but it may be prolonged to the third or fifth day, and in very rare cases to the tenth even.

Of 23 cases in which the issues have been recorded, 12 recovered and 11 died. In 9 of the 12 recovery seemed complete, but in 3 the constitution was deteriorated. In treating the disease, sometimes mere demulcents, at others astringents, the mineral acids and the internal use of cold, and in others applications to the belly and enemata, have been tried in different cases. M. Rilliet believes that the best treatment consists in the free exposure of the child to the air, the keeping its extremities warm at the same time, the application of astringents to the abdomen, and the careful administration of nourishment, or, if the child's condition requires it, of stimuli.-Gazette Médicale, 1848, No. 53.

On Catarrh of the Mouth. By DR. Preufer.

DR. PFEUFER Opposes the prevalent idea, that the appearances of the tongue indicate the state of the stomach, and that its loaded state or perverted sensibility shows the existence of gastric affection. He denies that it undergoes greater changes in the disease of the stomach than in those of any other part of the body. The stomach may be most extensively diseased by cancer, in which hyperæmia or blenorrhoea may be present, and yet the tongue continue clean and the appetite good, as also may be the case in chronic inflammation of the organ. The tongue may be loaded, and the appetite lost, in that catarrhal state of the mucous membrane of the stomach termed gastricismus, but it is by no means rare to find this not the case. the appetite may be gone, and the tongue be quite clean.

On the other hand, changes may occur in the cavity of the mouth without being at all indicative of disease of the stomach; the tongue may be thick and loaded, an indifference to food exist, and the taste be blunted and pasty, yet whatever the person does take produces no gastric suffering. The affection is, in fact, a catarrh of the cavity of the mouth. It may come on quite suddenly under the influence of mental emotion; it accompanies a variety of affections of the mouth and throat, and may be excited by various stimulating articles of diet, or by medicines acting as local irritants. It sometimes passes away in a few honrs, and at others lasts for days, and seldom requires treatment, and certainly not the use of emetics and purgatives, which are usually resorted to, the diligent rinsing the mouth with cold water hastening its removal. Occasionally, however, the affection lasts for weeks or months, and then is usually treated by a great variety of medicines as an obstinate dyspepsia; those who can afford it being at last sent to the Spas. These means,

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 phlegmLeeches 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 Hôpitaux, 1849, No. 12.

on.

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 Hôpitaux, 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 that 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 non-inflammatory articular rigidity, he forcibly extended the arm, notwithstanding the