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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 an 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 Medico-Chirurgicale, t. v. pp. 177-80.

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. She 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 Hôpitaux, No. 64.

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 too 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 spmpathetic 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 prac tically 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 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 immovable. 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 fiee, 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 citatrize, 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 transparancy 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 becomes 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 taken 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 7-IV. 25

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-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 iflnammation. 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 previously 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 antreior 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 ob serves, 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 inimitable 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.

On the Employment of Collodion in Ophthalmic Affections. By M. HAIRION. To be enabled to protect the inflamed cornea from the contact with the air, prevent the movement of the eyelids over its surface, and retain topical applications long in contact with it, are objects which, if realized, would much diminish the severity of keratitis and conjunctivitis. Attempts at accomplishing these ends by the use of court plaster and the like had failed in the author's hands, when collodion offered itself to his notice. He usually applies it to the eyelids of one eye, and afterwards, if both eyes are diseased, to the other; but circumstances may render its simultaneous use necessary. The adhesion never lasts longer than forty-eight hours; frequently not so long, and has to be reaccomplished. The discharges from the eye usually work out a small passage, or a little space may be left at the angle of the eye, without interfering with immoveability. This often forms an admirable means either of securing rest and darkness for the inflamed conjunctiva or cornea, or of enabling us to make effectual application of various ointments to the ocular surface. Then again, in the various perverted conditions of the eyelids, as in trichiasis, distichiasis, entropion, ectropion, &c., the ease with which, by collodion, the desired rectification can be secured, renders it a most valuable palliative and even curative agent.-L' Union Médicale, Nos. 29, 31.

Neuralgia of the Glans Penis. By DR. SPENGLer.

DR. SPENGLER relates an interesting case of this rare affection. It occurred in the person of a healthy man, 40 years of age, who, having been cured of gonorrhoea four weeks, had connexion with his wife, ten weeks after the first infection. This was attended with the most intense suffering in the glans penis, which continued for two or three days, and always returned whenever he repeated the act. At last, abstinence from connexion procured no immunity; for, if he had a pollution, or even an erection, though this was not painful while it continued, the like intense pain came on afterwards. In the intervals he was quite free from pain or tenderness; no marks of inflammation were present; and an instrument found the canal quite free. The case being considered a pure neuralgia, every variety of treatment was resorted to in vain for weeks and months, until the man became hypochondriacal, and contemplated amputation or suicide. At last, Dr. Spengler cauterized the canal, with the effect of producing a bloody, puriform discharge, and some relief; and, by repeating this four times, at long intervals, he became quite cured. The author quotes a somewhat similar case from the 3d vol. of the Mem. of the London Med. Soc.' (1797), in which a man, after an impure connexion, contracted an excessive pain in the glans, to which no means that were tried afforded any relief, and which, in fact, was only cured several months later by the acquisition of a new gonorrhoea.-Casper's Wochenschrift, No. 46, 1848.

On Counter-openings. By M. DIDAY.

THE author observes that surgeons have either given no directions, or only such as are erroneous, for the mode of making counter-openings. The intention of these being to prevent the burrowing of pus, certain conditions are to be observed.

1. The internal orifice of the canal about to be created is to be situated at the very extremity to which the detachment of the tissues has extended. 2. The new canal must traverse the tissues in the most favorable direction for the free issue of pus. Inguinal suppuration has a great tendency to produce suppuration, the burrowing inwards at the genito-crural bend being greatly favoured by position and the lamellar character of the cellular tissue. If a counter-opening is made perpendicularly to the surface of the skin, large as this may be, the detachment of parts still goes on, as the pus, to enter it, would have to penetrate against the action of gravity. The artificial canal must therefore be itself vertical; to accomplish which end the tissues must not unfrequently be passed through obliquely rather than

3. The open

directly, the route being, in fact, a longer but more accessible one. ing must be large enough, though this is a matter of less consequence if its situation and direction have been well chosen. 4. The new track should be of as equal a diameter as possible throughout. 5. It must be so made as to allow of the introduction, not only within the lips of the incision, but into the whole extent of the canal, of a tent of lint or charpie, without which its permeability cannot be maintained.

Supposing the above indications to be correctly laid down, they serve to show the erroneousness of the present practice, viz. the projecting the point at which an incision is to be made on a grooved conductor, and cutting down upon it from without inwards. This is sometimes difficult, and causes unnecessarily large incisions, and undue manipulation of the part. It is, in the author's opinion, a capital error to incise from without inwards; and after having ascertained, by means of a probe, the direction of the sinus and that of the desired opening, he passes in a small trocar with its canula, not exceeding a probe in size, and, having reached the extremity of the sinus, thrusts the trocar forward with some degree of force, so as to make its point appear through the skin at the desired place, after which he removes it, leaving the canula in situ. The incision, however, usually requires further dilatation, and to this end he places the point of a straight bistoury in the end of the canula, which projects externally, and by pushing in the one while he withdraws the other, the entire track of the wound is equably enlarged. The canula is again introduced for the purpose of affixing the tent to it.—Gazette Médicale, 1849, No. 1.

On a Substitute for Tents in dressing Abscesses. By M. NONAT.

In place of introducing tents, which are not only painful, but give rise to other inconveniences, M. Nonat passes a crayon of nitrate of silver into the opening, to the depth of from to I centimetre, withdrawing it immediately. The pain caused by this is trifling and evanescent, and the eschar produced prevents the union of the walls of the trunk of the abscess. It is in abscess of the breast that this procedure has been found especially useful; the deepest abscesses being thus brought to heal in seven or eight days. The cauterization has to be repeated every two or three days.-Gazette des Hôpitaux, No. 23.

On Amputation of the Penis by means of the Actual Cautery. By M. BONNET. THE actual cautery has been occasionally resorted to for the purpose of arresting dangerous hemorrhage after this operation; but during the last five years M. Bonnet, of Lyons, has employed it for the execution of the amputation itself, by which means he not only prevents hemorrhage, but what is of more consequence, phlebitis, and purulent absorption. He describes his success as very gratifying, After heating the iron, the patient is subjected to the influence of chloroform, and wet compresses are disposed around the penis. An assistant holds the organ by means of a forceps, and the surgeon, standing on the left of the patient, gently applies the iron perpendicularly to the axis of a healthy portion of the back of the penis, the division of the fibrous structure often requiring more than one such application. This accomplished, the iron is gently passed into the corp. cavernos., so as to coagulate the blood of its vessels, and the section is completed without loss of blood; four or five applications of the iron being wanted in all. When the cancer extends to the scrotum or abdomen, the operation is more tedious, as the ramifica tions must be followed by the cautery, though the pubis itself has to be reached. If the inguinal glands are affected, they should be removed by a bistoury, and the cautery applied. There is generally far less reaction than after ordinary amputation of the penis. In about a week the eschars begin to be detached in fragments, and they have all fallen in fifteen or twenty days. By this operation, then, we can much more readily act on healthy tissue, we are enabled to attack cases the knife could not reach, and we prevent hemorrhage.-Gazette des Hôpitaux, No. 18.

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