and a slight rising and extension of the left arm, were the only actions observable after the first few inhalations. The operation was now begun and completed in two minutes more. Thus, from the commencement of the inhalation to the completion of the operation only three minutes elapsed. The pulse, which at first beat 72 strokes in a minute, rose during the administration of the vapour to 120 strokes. At the end of the inhalation it became intermitting and after a short period was scarcely perceptible. A small quantity of spirit and water was administered. After the lapse of five minutes sensibility appeared to be returning, and he muttered something in which he made use of the word "mother." He afterwards said he thought he had been walking with her. It was fifteen minutes before he became sensible of surrounding objects. He knew nothing of the operation that had been peformed on him,—said that he had been asleep, that he had experienced no unpleasant sensations, and that he wished to go to sleep again. He says that he felt drowsy for two hours. The patient never had an unfavourable symptom; the only dressing used was cold water; and at the end of a fortnight he resumed his thick boots and returned to his labour. OPERATION FOR LITHOTOMY PERFORMED UNDER THE INFLUENCE OF ETHER: DEATH. TO THE EDITOR OF THE PROVINCIAL MEDICAL AND SURGICAL JOURNAL. SIR, At a time when the attention of both the medical profession and the public is being called to the influence of æthereal vapour, as an agent in diminishing pain during surgical operations, you may probably consider the accompanying case of sufficient interest to be admitted into your columns. I am, Sir, Yours obediently, ROGER S. NUNN, Surgeon to the Colchester and Essex Hospital. Colchester, February 26, 1847. On Friday, the 12th inst., I operated upon Thomas Herbert, aged 52, the subject of stone in the bladder, in the presence of most of the medical gentlemen of the town and neighbourhood. The æther was exhibited by my colleague, Dr. Williams, who considered the patient to be sufficiently under its influence after inhaling it seven or eight minutes, at the end of which time I commenced the operation. There was neither difficulty nor loss of time in cutting into the bladder; but having done that, some little delay occurred in grasping the stone, which was small, very flat, and lying in the posterior part of the bladder. The delay was also increased by the extremely relaxed state of the bladder itself, which seemed to fall in folds upon the forceps, and to cover the stone. The time occupied from the commencement of the operation to the period when the man was unbound, was ten minutes, during which the a:her was administered at intervals. The patient was placed fully under its influence, and the breathing first became heavy, and ultimately stertorous. He recovered, however, from its effects after a short time, and continued in a quiet passive state, but without decided re-action, for twenty-four hours. At this period he had a severe chill, which lasted for nearly twenty minutes. Mr. Taylor (the house-surgeon,) immediately gave him two ounces of brandy, with an equal quantity of water, after which the patient remained in a dozing state till eight o'clock p.m., when the housesurgeon considered it necessary to send for me, as a state of complete prostration or collapse had ensued. I ordered small quantities of brandy and water, (half brandy,) with arrow-root, at intervals, wrapped him in hot blankets, placed bottles of hot water in the bed, &c. This treatment was kept up till nine o'clock the following morning, when ammonia was given, alternately with the afore-mentioned stimulants. The patient seemed incoherent from eight o'clock p.m. of Saturday, till nine a.m. of the following day, when symptoms of slight re-action appeared. At a consultation of the medical staff which was held at this time, it was determined that the same treatment should be continued, (modified according to circumstances,) and that in addition, a stimulating injection should be exhibited. The effect of the injection was to increase slightly the frequency of the heart's pulsation, but without exciting his nervous energies. From this period he gradually sank, and died at five o'clock, p.m., being sensible to the last. I should here mention, that the small vessels which are necessarily divided in making the first incision, shewed much inclination to bleed, owing, I imagine, to their want of contractile power; I therefore, to prevent any unnecessary hemorrhage, secured them immediately after the patient was put to bed, so that he did not lose much blood. Post-mortem, sixty-seven hours after death. Membranous congestion of the brain, but no effusion; brain firm; lungs permeable throughout, anteriorly exsanguineous, posteriorly engorged; heart flaccid, of a natural size, and nearly empty; left kidney pale, the right slightly congested; the bladder and the adjoining parts presented the usual aspects after an operation. (Signed,) E. WILLIAMS, M.D., ALDERMAN PARTRIDGE, ROGER S. NUNN, I would mention that the blood throughout the whole vascular system, was in a perfectly fluid state. It is not my intention or inclination to attribute the loss of my patient wholly to the influence of the æther which was administered in this case, nor hastily to decry its use under all circumstances connected with surgical operations; but still, I feel called upon to bring before the notice of my medical brethren, the effect which resulted from its exhibition in this instance, that the profession may judge from the recital of an unsuccessful case, GENERAL RETROSPECT. how far it may be considered safe to employ æther 135 is the consequence of an increased development, both of the vascular membrane and of its epithelial invest ment. The blood-vessels of this mucous tissue and the utricular glands increase in volume, and their interstices are occupied by elementary cells of new formation, many of which are destitute of nuclei. In the human female, the uterine glands are enlarged after conception, and become tortuous and of an utricular form. As in the stomach, these glands are placed perpendicularly to the mucous surface, their orifice being towards the cavity of the organ. These orifices have been long known to exist in the deciduous membrane, to which they impart a cribriform aspect. In prosecuting the operation, there was nothing peculiar to attract my attention, or to lead me to consider the patient's physical condition differed from that of those on whom I had before operated, until I had reached the bladder, when I cannot but attribute the difficulty in The uterine glands in the cat and bitch are only seizing the stone to the apparently collapsed state of that enlarged to any amount at the spot on which the viscus, which had fallen in folds over the calculus, and placenta is implanted. They are at all times visible so prevented its bring grasped by the forceps. I must in these animals, independently of pregnancy, and not, however, omit to mention the fact, that the patient consist of two species of glands; one small and simple, expressed no signs of suffering during the operation. the other larger and branching. Both increase after Thus far, therefore, it may be said the æther fulfilled its conception; the former throughout their entire length; intended office; but I think another question is involved the others principally at that part which is nearest the viz., whether the artificial means thus employed may intra-uterine orifice. At a certain point the trunk of not produce very serious depressing effects on the the second order of glandules enlarges in the form of nervous system, depriving a patient of that re-active a pouch, which touches the parietes of the neighbourpower so necessary to the reparative process? Has not ing blood-vessels, which convey the maternal blood. a patient, after the administration of æther, a double The villosities of the chorion which contain the ultimate shock to overcome,-that produced by the vapour, superramifications of the umbilical vessels of the embryo, Does not the hisadded to that of the operation itself? penetrate into the orifices of these uterine glands, and tory of the post-mortem examination bear out the sus-expanding in their cavities, form with them a single picion of the depressing influence of this inhalation? positively, from the still fluid state of the blood, (although the body was not opened for sixty-seven hours after death,) and from the flaccid state of the heart,-negatively from the fact that the inspection detected no indications of violence done to the parts that could explain the rapid dissolution which ensued, and that there was no evidence of Nature having made the slightest effort towards local reparation. Pain is doubtless our great safeguard under ordinary circumstances; but for it we should hourly be running into danger, and I am inclined to believe that pain should be considered as a healthy indication, and an essential concomitant with surgical operations, and that it is amply compensated for by the effects it produces on the system as a natural incentive to reparative investment to the embryonic vessels. This membrane and its duplicatures surround the uterine blood-vessels, which, as has before been said, ramify on the interstices of the glands. After this union, the part of the membrane which was derived from the parietes of the uterine glands, becomes sensibly thinned by absorption. Once formed, the placenta of the bitch is traversed by a dense network of tortuous capillary vessels, which conveys the maternal blood. Each of these capillary vessels is closely invested by a membrane, which contains a fine network of capillaries, derived from the vascular system of the embryo. appears that the foetal blood flows through a vascular network, over the surface of the larger vessels which contain the maternal blood. The two sets of vessels, however, do not communicate directly. It thus In the human female, the uterine glands appear to be increased in size over the whole surface of the uterus. Weber has not noticed that one part of their trunk dilates more than another, neither has he observed that the villosities of the chorion penetrate their cavities as in the bitch,-on the contrary, they are perfectly free. This difference in the formation of the placenta in the human female and in the bitch, is thought to be in some manner due to the formation of a "decidua reflexa." The human placenta then differs from that of the bitch:-1st. The dense network of vessels which conveys the maternal blood and traverses the entire placenta, consists in the human female of tubes of a much larger diameter, but with thinner walls. 2nd. The other constituent part of the placenta, the villosities | be borne with comparative impunity, while the repe of the chorion, which convey the fine network of embryonic capillaries, form in the bitch, membranes and folds, and in the human species ramifications, which terminate in fine threads, interrupted here and there by nodular enlargements. tition of it may keep up nausea and intestinal irritation, so as to cause injurious prostration. This is very likely to happen in cases of a chronic character, like hooping-cough. Although mild emetics are among our best remedies in this disease, and where the subject is old enough, a single emetic of antimony is frequently exceedingly beneficial, yet the repeated use of anti In the perfectly formed placenta, both in the human female and the bitch, the vessels which convey the maternal and fatal blood are in intimate apposition.monial emetics, as is too often the case, appears to me This is effected in the bitch, by the first named vessels being closely enveloped by the villosities of the chorion; but in woman the reverse is the case, the ramifications and the filaments of the villosities being surrounded by the enlarged vessels, which carry the maternal blood. If it should eventually be demonstrated that the villosities of the chorion penetrate into the cavities of the uterine glands in the human female as in the bitch, the opinion above given will not be interfered with, for it will still be necessary to prove that the terminal filaments of the villosities are inserted, and as it were, soldered to the walls of the uterine glands. Archives d'Anatomie, Dec., 1846. PRACTICAL MEDICINE. ON THE EFFECTS OF EMETICS IN YOUNG CHILDREN. [The following remarks, by Dr. Beck, are worthy of attentive consideration, and we believe from frequent observations of the manner in which pulmonary diseases of infants are treated, that they are in no wise exaggerated :-] 1. As a general rule we need not be afraid of vomiting the youngest child, provided the means used are mild, such as ipecacuanha, &c. The mere act of vomiting is attended with no danger, while the remedial agency of an emetic is one of great power and value. Besides acting on the stomach, it extends its influence to the mucous membrane lining the pulmonary organs, promoting secretion in the first place, and then aiding in dislodging and ejecting morbid accumulations; accordingly, in pulmonary affections, there is nothing so efficacious. 2. The vomiting induced by the preparations of antimony ought to be resorted to with great caution in very young children, and should never be used except in those cases where a sedative effect is required, and can be borne with safety. Inflammatory excitement ought then always to be present to justify its use in a young child. Where the object is simply to evacuate the stomach, it ought never to be thought of. In such cases as croup and pneumonic inflammation, it may be justifiably and beneficially used. In these cases it will be found that the system can bear the sedative influence of the antimony much better than it can in the ordinary conditions of the system. Even here, however, care should be taken not to push the antimony too far, as dangerous collapse has been known sometimes to be the result. 8. The continued use of tartar emetic in young subjects cannot be too specially guarded against. It is in this way, probably, that it is so apt to prove injurious. A single dose, even though it vomits very freely, may to be a great error in practice. It is not indicated by the nature of the symptoms, and violates a great rule which ought always to be observed in the management of chronic cases, and that is, not to break down unnecessarily the strength of the patient. Again, in ordinary catarrhal affections in children, a good deal of mischief is frequently done by the continued use of expectorant mixtures containing this active article. 4. As the effect of tartar emetic on the system cannot always be measured by its emetic operation, even in the adult, this fact ought to serve as a caution against the too common practice of giving repeated doses of it to produce vomiting in children, when they happen to be narcotized. While it fails to vomit, it may still operate as a poison to the system. In all cases of this kind, the proper method of treatment is, not to push the emetic, but to endeavour to restore the sensibility of the patient, and then sometimes vomiting comes on at once. 5. In using tartar emetic in children, especial regard should be had to their constitutions. In those naturally delicate, and especially where the scrofulous diathesis exists, it should never be used if it can be avoided. Prostration is much more apt to ensue in them, and where the article is persisted in for any length of time, is sure to do harm. It is in such constitutions, when labouring under hooping-cough, and where the use of this article has been too long continued, that the baneful effects of it are most strikingly observed. 6. It is perhaps hardly necessary to say, that if tartar emetic be an article of such danger, the younger the subject to whom it is given, the more likely is it to do harm. In children under a year, I should say, as a general rule, it ought never to be used. During that period, the powers of life are too feeble to bear so active a remedy, at the same time that all the beneficial effects of an emetic may be gained from the use of ipecacuanha, or even milder means.-New York Journal of Medicine, and Dublin Medical Press, Jan. 20, 1847. SURGERY. ERECTILE TUMOUR OF THE HEAD OF THE TIBIA; LIGATURE OF THE FEMORAL ARTERY DEATH. This instance of a disease which has only of late years attracted the attention it deserves, occurred at the Hotel Dieu of Toulouse. The patient, a female, aged 25, experienced for the first time, about March, 1843, indistinct pains in the left leg. These pains were transient and did not impede the motions of the joint. About the middle of the year she fell from a chair and struck her limb, after which the disease from which she eventually died, declared itself more positively. A tumour was now GENERAL RETROSPECT. a cure. 137 perceptible in the region of the head of the tibia, which Dupuy, it is in many cases in itself sufficient to effect was leeched by the surgeon in attendance, as may be imagined, without relief, but on the contrary it rapidly increased in size, until November, when it exhibited the following appearances :-At the upper part of the left leg immediately below the knee, an irregular tumour was perceived, consisting of two unequal elevations, hard and resisting, incompressible and not painful on pressure. Pulsations were also plainly perceptible isochronous with the arterial diastole; there was also a slight bruit de soufflet. Both the pulsations and bruit ceased on compression of the crural artery. The knee-joint and the poplitieal space were in their natural condition; the general health was good. The diagnosis was, erectile tumour of the head of the tibia. The operation decided upon, namely, ligature of the crural artery, was performed in the January succeeding, the female being at the time five months pregnant. As soon as the ligature was applied, the pulsation in the tumour entirely ceased. The next day the tumour was considerably diminished in size, and the patient was to all appearance doing well in every respect; but it was speedily observed that suppurative inflammation of the cellular tissue had supervened; pleurisy with effusion followed, and the patient died at the end of the week, after having miscarried. Post-mortem. Sero-purulent effusion in the left pleura, with compression of the lung; other organs healthy. The cellular tissue of the thigh on which the operation had been performed, was filled with pus, which had burrowed among the muscles in every direction. On removing the integument from the tumour, it was found to be hard and incompressible in' some parts, fragile in others, and crepitating on pressure like dry parchment. In some points the bony tissue had completely disappeared. A division of the head of the tibia shewed that the tumour was composed of a tissue of varied colour, being yellow in some spots, rose-coloured in others, and spotted so as to resemble a section of the brain. The mass of the tumour appeared to consist of two substances,—one of a chalky white and inorganic, the other having an areolar appearance and appearing to contain the former. Here and there masses resembling fat appeared, as well as spots, having the aspect of softened encephaloid matter. These varieties of diseased structure had entirely replaced the spongy tissue of the bone, but the cartilage was unaffected. The more solid formations of the bone were reduced to a complete shell. No Tessel of any size was traced into the tumour.-Gazette des Hopitaux, Jan., 1847. ON THE TREATMENT OF CERTAIN SURGICAL AFFEC- The question meets us in limine. What are the phenomena which are induced by elevating a part of the body? If the hand, for instance, be allowed to hang down, we observe that it becomes engorged with blood. Place it in the contrary position, and the livid colour disappears, and the vessels empty themselves. It is evident from this experiment that in the first instance the blood accumulates in the most depending part; in the other the reverse occurs, the blood readily finding its way towards the centre of the circulation, What is thus seen to occur in a healthy condition of parts, also happens under certain modifications in disease. M. Dupuy gives the following account of the practical application of the above principles: Once so If the thumb or hand be inflamed, the patient is made to lie in such a position that the elbow is maintained in a position higher than the shoulder. The fore-arm is placed perpendicular, supported by cushions, care being specially taken that the circulation is not impeded by bandages; the hand is then enveloped in bandages, to which tapes are fixed, and attached to the top of the bed. These means, with some simple modifications, are likewise made use of in inflammation of the lower extremities. M. Gerdy raises the end of the bed by placing a chair under it, thus raising the foot upon the summit of an inclined plane. placed, and care being taken that no injurious pressure is exerted, the patient must not move from the position even to satisfy natural wants; for he may destroy in a few minutes all the benefits which have been obtained by whole days of repose. Although elevation cannot be so efficaciously applied to the head and trunk as to the extremities, it yet may be employed to a certain extent. Supposing the eye to be inflamed,—the patient will lie with his head high, and on the opposite side to the one affected. Why are inflammatory affections and discharges from the womb so tedious in recovery, but for the stagnation of the blood in the organ? Let a woman, who has been accustomed to keep herself in the vertical posture, go to bed, and raise her hips by means of pillows, and she will soon find her case amended. The same principles apply to inflammatory affections of the face, breasts, &c. The advantage of this plan of treatment is not, however, confined to inflammation, but it is equally serviceable in ulcers, uterine hæmorrhages, and varicose veins. In many instances of the latter disease, in M. Gerdy's wards, elevation alone of the limb has been completely successful. The utility of the plan is also incontestible in varicocele. The communication of M. Dupuy terminates with these conclusions: 1st. That elevation of the diseased part is able, without the intervention of other therapeutical measures, to cut short certain inflammations, if it be employed sufficiently early. M. Gerdy has for some time been in the habit of treating certain inflammatory affections by placing the limb, or part, in such a position as to favour the returning the quantity of blood in the part. of blood to the heart. This plan has this advantage, that it does not exclude the application of the usual means of treatment; but, as is shown by M. 2nd. That in phlegmon it relieves pain by diminish 3rd. That it advances the cure of engorgements and chronic profluvia of the uterus. 4th. That certain hemorrhages may be suspended by it. 5th. That it is able to cure certain ulcers of the cation to Dr. Jeffreys, in the last number of our Jower extremities. Journal, bas emboldened me to address this note, 6th. That varices and hæmorrhoids areadvantage. which, if you think worthy a place in the pages of the ously modified by elevation. Provincial Medical and Surgical Journal, you are at liberty to insert. 7th. That where it is not sufficient in itself to effect a cure, it is always a potent auxiliary.-Archives Générales, Nov., 1846. METHOD FOR PREVENTING THE PROJECTION OF THE I am, Sir, Your most obedient Servant, Pocklington, Yorkshire, BIOGRAPHICAL NOTICE OF THE LATE Mr. The leg is to be placed in the bent position on the outside, with a common side splint placed above and below, slightly hollowed out to fit the leg. In addition to these, two straight splints are used, padded on one side,-one of sufficient length to extend from the patella to the upper part of the lower third of the leg, TO THE EDITOR OF THE PROVINCIAL MEDICAL AND the other long enough to reach from the hollow of the knee to beyond the heel. If the straps be now passed round the leg, including the shorter of the two straight splints on the front, and the longer splint on the back of the leg, along with the two bottom splints on the upper and under side, the tibia and fibula above the fracture will be pushed backwards, whilst the foot with the part below the fracture is pressed forwards. In this manner the tendency of the tibia to pass forwards, after simple dislocation or fracture near the ankle, is effectually prevented.-Ormerod's Clinical Observations, p. 52. ON THE COMBINATION OF SENNA WITH TO THE EDITOR OF THE PROVINCIAL MEDICAL AND SIR, I have frequently used matico in cases of hæmorrhage, but I was much pleased about three months ago, with the benefit obtained from combining it with senna, in a case of typhus fever, where hæmorrhage from the bowels took place. As I had previously attended to the state of the liver, &c., I immediately ordered Matico and Foliorum Sennæ, utrq. dr. ij., to be infused in a pint of boiling water, and a wine glassful to be taken frequently. Scybala mingled with blood soon passed the intestines, after which less blood flowed, and by continuing the above mixture in similar doses at various intervals for three or four days, during which time the alvine evacuations gradually improved, my patient soon got rid of this troublesome symptom. SIR, SURGICAL JOURNAL. lamented friend, Mr. Dodd, published in your last In the biographical notice of my excellent and number, there is a slight error which I will thank you to correct at your convenience. I am desirous that this should be done, not so much for my own sake, or for the sake of the eminent friends who at different times saw Mr. Dodd along with me, (viz., Sir James Clark, Dr. Watson, and Dr. Walshe,) as for the sake of auscultation, which might be supposed, from this statement, to have faltered egregiously in a very simple case. The passage I refer to is the following:-"There was much gravitation in both lungs posteriorly, but principally in the right, where the greater portion of the posterior lobe was gorged with blood, and was very friable. There was, however, in this situation, neither fibrous nor any other deposit, except the infiltration of blood, nor hepatization or any adventitious growth, though it was in this situation, and this only, that disease had been long suspected." Now, the truth is, that some years before my poor friend's death, all the gentlemen above mentioned, as well as myself, had, on separate examinations, recognized discase in the upper lobe of the right lung, and subsequently in the left, and none in the inferior lobes. In some notes now lying before me of the last examination I made, (Sept. 27th, 1846,)I find the signs indicate as close an approximation to the condition of the lungs found on dissection as could reasonably be expected to be made four months before death. The principal of these signs are:-Greater dulness of the right side generally than the left, anteriorly; greater I make these hasty remarks in order that this remedy, dulness of the left side than the right over the lower (Matico,) which I consider one of the most valuable lobes, posteriorly; great dulaess on the axillary aspect additions lately made to the Materia Medica, may be more on the right side; a comparatively good sound on the used in the various forms in which disease is constantly lower portion of the right back. On the right side, restaking place in these wondrous coils, whose healthy piration cavernous above the clavicle, with pectorilofunctions are so essential to the well-being of man, quy, (the parts here greatly sunk in,) also on the and the inferior animals. I used this combination with sternal border of the subclavicular region; strongly a view, not only to arrest the hæmorrhage, but also to bronchial on the axillary face; in many places the resprevent the diarrhoea which frequently follows it in piration extremely feeble or null, with various forms fever cases. Anything which will obviate this, is worthy of rhonchi, crepitant and others. On the lower portion of the attention of those who are anxious to combat, of the back the respiration strong, (puerile ;) higher alleviate, or remove the sufferings, in every form, of up, in the scapular, intra-scapular, and supra-scapular their fellow creatures. regions, there is the same marked crepitus as anteThe publication of Dr. Hartle's valuable communi- riorly. Nearly the same state of things was found on |