of the interior of the vessel, and slight increase of its calibre, is characterized by certain well-marked physical signs, which will enable it in the majority of eases to be readily diagnosed. 5thly. That the physical signs of this morbid condition of the arch of the aorta resemble those of valvular disease, and have probably often been mistaken for it. 6thly. That the form of valvular disease with which it is most liable to be confounded, is a state of the semilunar valves of the aorta permitting regurgitation, which it resembles in a murmur accompanying the second sound of the heart, in the jarring pulse, and in the visible pulsation in the arteries; symptoms which heretofore were supposed to be pathognomonic of regurgitations through the aortic orifice. 7thly. That the morbid deposits which occur in the arch of the aorta are not the result of inflammatory action either of an acute or chronic character; neither can they be considered as the result of the natural degeneration which the tissues undergo in advanced life; but that they ought to be ranked among adventitious deposits. 8thly. That dilatation of the arch of the aorta is more frequently the result of regurgitation into this vessel from the large branches which come off from it than of the increased force with which the blood is propelled by the left ventricle, or than of any impediment to its passage through the remote or terminal branches of the aorta. 9thly. That our knowledge of the fact that regurgitation into the arch of the aorta occurs in cases where this vessel has become inelastic from disease, enables us to explain the cause of the second sound heard in cases of aneurism of the arch of the aorta, and to account for the second impulse felt where the aneurism forms a tumour externally.-Dublin Medical Press, April, 1847 SURGERY. ON THE EMPLOYMENT OF ISSUES. After a severe but just criticism upon the ordinary method of employing issues, the author gives the following account of his own notions upon the subject. He observes: I would recommend, instead of using the remedy in the manner which I have condemned, in the foregoing paragraphs, a method which, as I shall presently attempt to explain, seems to have reason on its side, and of the great value of which I have fully satisfied myself by experience. Issues should be made of moderate size, and before the effects of the one first made are lost, by the process of repair of the ulcer being completed, another should be made at a distance from the former, so as to act upon another part of the joint affected; (for here I may be allowed to mention that this is frequently required in joints of considerable size, an issue on one side of a joint often relieving the side to which it is applied, but seeming to have little effect on the part of the joint remote from it.) Before the ulcer made by the last formed issue is nearly healed, a fresh portion of the skin should be destroyed by the caustic, and again and again should this process be repeated varying its position around the joint; and thus should a regular diversion from the diseased part be kept up. There may be reasons in some cases for not carrying out this plan to the letter, as regards the destruction of fresh portions of skin on each application of the caustic. In such cases, or where the patient has great objections to it, a new plot of skin need not be destroyed on each occasion that the caustic is used, but Sir B. Brodie's plan of frequently rubbing the old sore with caustic may be adopted; but, as a general rule, I do not consider it so efficacious as the destruction of a fresh portion of skin, nor is the benefit so lasting, and consequently, the caustic requires to be applied much oftener than where fresh skin is destroyed. Undoubtedly the latter is attended with more pain; but its duration is short, and it is not followed generally by the irritative consequences of blisters, and some other counter-irritants, or, I may add, of issues, kept open by peas and pressure. Scars may be regarded as one inconvenience arising from this plan; but if we can obtain greater benefit to diseased joints by the application of the caustic to fresh portions of the skin, the scars appear to me of trivial importance, even in the case of the fair sex; for the joints, commonly the seat of the disease, are, for the most part, clothed, or at any rate may be kept so without any great drawback to the personal charms of any young lady. The introduction of peas or other bodies for the purpose of keeping issues open, I would in no case recommend. If from any cause it be judged fit to keep open the same issue, let it be touched with caustic, but not kept open, even in this way, for any great length of time, or it will become comparatively useless. During the treatment of a very considerable number of cases in which I had the opportunity of employing issues in this way, I found it to be the most efficacious mode of using them; and the principle, although not carried so far, has been fully confirmed in my mind, in a very extensive field for observation, by watching attentively for several years, the patients under the care of Mr. Vincent, in St. Bartholomew's Hospital.Lancet, April 24th. EXOSTOSIS AND ITS TREATMENT. M. Roux terminates a long memoir on this subject with the subjoined conclusions: 1. Among the various tumours of bones, there are certain to which alone the term exostosis is applicable, and which should be carefully distinguished from all others. 2. These, like the bones themselves, are composed of spongy tissue, enclosed in a more compact shell, or in other cases of the compact tissue only, in which case they resemble ivory. 3. Every exostosis of this kind is joined to the bone, from which it springs by a short narrow pedicle. 4. These tumours never surpass a certain degree of development. 5. Their volume is in general proportinate to the size of the bone from which they spring, being small on small bones, large on those of greater dimensions. 6. In general also they are not connected intimately the pedicles of the tumours with the solidified caustic to the soft parts by which they are surrounded. 7. They do not undergo degeneration, but preserve their primitive structure for an indefinite time; the only change which they experience is that of density. 8. These tumours produce a variable degree of inconvenience, according to their locality. of Vienna. The dangers which attend excision, and the hemorrhage so frequently observed as a conse. quence of that operation, have induced many practitioners to prefer the actual cautery; but this method is one of difficult application, and the results which it yields scarcely compensates for the suffering which it 9. They might always be removed, if in some they causes. The new operation, according to the inventors were not inaccessible from situation. 10. They may be removed without being previously exposed, and though in some cases the operation is followed by severe consequences, it is in general successful.-Revue Medico-Chirurg., Mars, 1847. SIGNS OF FRACTURE OF THE CERVIX FEMORIS. In allusion to a case recently occurring in the person of a woman, aged 53, M. Velpeau made the following remarks:--" Pain and swelling are signs of little consequence, as they may equally exist in fracture or sprain. The impossibility of raising the heel from the bed is a sign. It may certainly be present also in a painful affection of the joint; but in the fracture of the cervix there is an absolute impossibility of raising the limb, while in this other affection this may be done if the pain be disregarded. Thus, in a luxation, the patient seems at first unable to raise the limb, but he can do so by perseverance. Eversion of the foot is not a pathognomic sign, as it may exist in other lesions, e.g, luxation on to the pubis; but in the case of luxation, not only is the limb everted, but neither the patient nor the surgeon can change its direction, while in fracture the surgeon easily turns the foot inwards. There are other affections in which the foot is rotated outwards, as in paralysis, and certain painful affections of the hip. The admeasurement of the limb is of great importance, but it is of much more difficult accomplishment than is generally believed. The inclination of the axis of the pelvis, or of the limbs themselves, often gives rise to apparent differences, against which we must be on our guard. We must never depend on mere inspection, but must carefully measure the limb after having placed the patient on his back, and take care that he lean neither to one side nor to the other. In these persons, and in those in whom the bony points is prominent, it is easy enough to measure from the iliac spine to the upper edge of the patella; but there are persons in whom the iliac spine is so rounded off, that we cannot be certain that we are applying the tape upon exactly corresponding points upon the two sides, and an apparent difference, amounting to some lines, may result. So also the patella is not only a fixed point, but its superior angle may be somewhat higher on one side than on the other. In this way several slight errors conjoined may give rise to the belief in a shortening, which has no real existence. By carefully guarding against any obliquity of the pelvis, ascertaining exactly the position of the superior anterior spinous process, and carrying the tape down to the malleolus, instead of the patella, we shall avoid all serious errors.—Medico-Chirurgical Review, Jan., 1847; from the Gazette des Hôpitaux, No. 68. M. Amussat, is more fortunate in its results, exposes the patient to no danger, and to less pain than the other methods. M. Amussat does not think it necessary, after destruc- TREATMENT OF STRICTURE OF THE URETHRA BY Mr. Goodman, of Manchester, in a late number of the Medical Gazette, relates the following case :-A man applied to him for relief, having a stricture in front of the bulb, of old standing. Four months before a smallsized bougie could with difficulty be passed, and on the time of application to the narrator of the case, total retention had ensued, after drinking freely of beer. An attempt was made to reach the bladder by appropriate bougies, but ineffectually, and it was therefore determined to have recourse to the forcible application of warm-water injections to the strictured part. After introducing a gum catheter as far as the stricture, where it was well secured by a band of tape, and compress placed upon the penis to prevent escape, a syringe-full of warm water was injected with some force, and was found to pass with tolerable ease. On removing the apparatus the man micturated immediately in a stream about the size of a crow-quill. A second application caused a still farther increase in the stream of urine, and the patient left for the time perfectly relieved. MERCURIAL ACTION NOT A PREVENTIVE OF SECONDARY Mr. Holmes Coote has written a short paper for the purpose of showing that the full and distinct action of mercury, though it cures the primary symptoms of syphilis, is not the sure preventative of secondary contamination which it is commonly thought to be. To prove this he has recorded fifty consecutive cases of patients suffering from severe secondary and tertiary This method consists in the circular cauterization of symptoms, of which seventeen are related in the NEW OPERATION FOR INTERNAL PILES, present communication, from the analysis of which he determines that mercury is unable to eradicate the venereal poison.-Lancet, April 24th. DIAGNOSIS OF A MERCURIAL SORE. In a valuable course of lectures on syphilis, Dr. Porter gives the following as the characteristics of the mercurial in contradistinction to the venereal sore : 1. Mercurial sores are not necessarily circular or oval in shape, neither are their edges regularly defined; on the contrary, they vary in these particulars, and assume different forms as they spread: their edges are often quite ragged, loose, and undermined, and their borders are often marked with a thin transparent cuticle, like that of a newly-formed cicatrix, extending quite around them, and giving them a silvery-white appearance. 2. The bases of mercurial sores are not hard, neither are their surfaces covered with the tenaciously adherent lymph so characteristic of venereal; on the contrary, the surface of the mercurial ulcer may present every variety of shape and appearance, sloughy at one spot, deeply excavated and rapidly ulcerating at another, with exuberant granulations at a third, and exhibiting a tendency to heal at a fourth. 3. But the most striking characteristic of the mercurial ulcer is, its tendency to spread, and the manner in which it enlarges itself. Venereal sores when not affected by phagedena increase slowly, and having reached a given size remain so: the mercurial generally spread quickly, and there seems to be no limit to the size they may possibly attain. I have seen an ulcer as large as my hand in each groin of the same individual, Mercurial sores, too, are easily distinguished from the venereal when they assume an herpetic character, and heal in one part whilst they are spreading in another, which the latter never do: this latter diagnostic is often extremely valuable in ulcers of the throat and on the penis, where any extensive loss of parts may be most sensibly felt during the life of the patient. The mercurial ulceration, too, often attacks the cicatrix of a recently healed chancre, and a fresh sore is thus formed a circumstance that does not happen to the true venereal sore, except by some accidental injury, or the application of a new infection.-Dublin Medical Press. TREATMENT OF CONSTITUTIONAL SYPHILIS IN THE INFANT. M. Trousseau has for several years followed the subjoined plan of treatment in these cases with success: He administers daily to both mother and child a sublimate bath; (Hydrarg. Bichloridi, dr. iij.-dr. vi.; Alcohol, oz. iij., to a common bath.) If the infant is nursed by the mother the latter is made to take the proto-iodide of iron; if the child is weaned it takes ten drops of the following solution three times a day: R. Hydrarg. Bichlor., gr. iv.; Aquæ, Oij. The dose amounts to about a 60th part of a grain.-Gazette Méd., Févr. 6, 1847. FORENSIC MEDICINE. QUESTION OF IDENTITY: ARE CICATRICES INDELIBLE? Medical Jurists have foreseen the case in which the condition of a cicatrix may be regarded as a means of But proving identity, and they have, moreover, mentioned the circumstances which may so alter their appearance as to prevent them from being recognized. instances of the actual necessity of referring to these marks in a medico-legal inquiry are comparatively few. The following case is one of the kind:-An Englisman, who was sentenced in 1828, to ten years' imprisonment and labour for forgery, obtained his dismissal after a brief period, on the condition that he should quit the While in prison it so happened that country for ever. he was inspected by the surgeon, M. Vandalaer, who remarked an indelible cicatrix of a burn. Having settled in France he was again pursued for forgery, and the police finding that he had returned to Brussels under an assumed name, demanded him to be given up. He was immediately arrested, but denied that he was the individual in question, in consequence of which he was transferred to Brabant to be identified. Some of the officials of the prison thought they reAt the trial the prisoner still persisted in his denial. cognized him, and others could swear to his identity, but no positive proof was forthcoming. The circumstance of the cicatrix was then recollected, and surgeons were called to examine the part. M. Vandalaer, in the first instance, was asked whether he recognized the mark, and replied that he did not, but that he did not consider its absence a proof of non-identity, as time and artificial means might have contributed to its removal. The same opinion being held by other medical men, the prisoner was convicted. It appears from the evidence of one of the surgeons, that the prisoners who are branded are in the habit of removing the cicatrix by placing over it a salted herring.(?)— Gazette Médicale, Avril 3, 1847. Medical Entelligence. THE MEDICAL REGISTRATION BILL. HOUSE OF COMMONS, Tuesday, May 14, 1847. Mr. Wakley moved that the subjects of the registration of legally-qualified practitioners in medicine, and the state of the laws relating to the practice of medicine in Great Britain and Ireland, be referred for consideration to a select committee, who should report the evidence, with their opinious thereon, to the House. After some remarks by Mr. Wakley on the advantages to be expected from a committee of inquiry Sir G. Grey observed, that although he did not think the objections which had been urged against many parts of the Bill of the hon. member for Finsbury ought to prevail, he was convinced that if that measure had been pressed now, any chance of satisfactory legislation on the subject during the present session would have been hopeless. He considered that the hon. gentleman was taking the more judicious course in asking for the appointment of a committee, before whom the various conflicting opinions which existed on this question might be expressed; and he (Sir G. Grey,) believed that such an inquiry would tend to lead to satisfactory results. He was willing to accede to the motion, on the understanding that the hon. member for Finsbury would not proceed with his Bill of age, labouring under stone in the bladder, was hy until after the committee had made a report. MAY 22nd, means of Mr. Atlee's inhaler, put under its influence. The operation with the knife was performed by Professor Sands Cox, and a large stone extracted under the minute, without the poor little sufferer evincing sensibility to pain. In the second case, a little girl, aged nine, a native of the town, suffering under scrofulous disease of the knee joint, amputation (under Committee nominated: Mr. Wakley, Mr. Macaulay, Sir James Graham, Mr. G. Hamilton, Mr. Bannerman, Mr. Acland, Mr. Hawes, Mr. Fitzstephen French, Sir Robert Harry Inglis, Mr. Dennistoun, Viscount Sandon, Mr. Boyd, Mr. Aldam, and Mr. Lascelles. Power to send for persons, papers, and records. Five the same influence,) above the knee, was rapidly to be the quorum. performed by Professor Knowles; not a sigh, murmur, nor the slightest expression of pain escaped her lips. In the third case, a boy, from Bilston, aged 14, with LEEDS HOUSE OF RECOVERY AND FEVER diseased ankle-joint, amputation was performed below HOSPITAL. We have just received the Annual Report of this Institution, for the year ending September 30th, 1846, from which it appears that the number of patients, chiefly fever-cases, admitted during the period, and especially in the last two months, was considerably greater than the usual average. the knee; narcotism, in this case, could not be in duced, although inhalation was persevered in for more than a quarter of an hour, and the case formed a striking contrast to the preceding. MEDICAL APPOINTMENT, It is stated that M. Berard, sen., is to succeed M. ROYAL COLLEGE OF SURGEONS. Gentlemen admitted Members on Friday, May 21st, 1847-R. P. Bayley; W. H. Brace; H. Tireman; R. Bentley; J. F. O'Leary; H. W. Slack; A. Somers; G. A. Wilkinson; W. B. Deacon; J. Ward; R. N. Bower. The average admissions of the preceding ten years Lisfranc, as Surgeon-in-Chief of the Hôpital la Pitiè, amounted to 329.7. The admissions of the year 1844-5, | Paris. were 329. The admission from October 1st, 1845, to October 1st, 1846, were 433, being 104, or nearly one third more than the admissions of the preceding year, and the general average, which, with 20 cases remaining on the books, give 453 as the number of cases under treatment. The number of deaths was 59, of which, eleven took place within twenty-four hours, and twenty-two others, thirty-three in all, within one week. The mortality was 13.606 per cent. nearly, or not quite, one in seven. The greatest number of admissions was in the month of August, amounting to 69; the smallest number in December and January, 24 in each. The admissions during the six winter months averaged about 30 each month; during the six summer months, rather more than 42; but the increase in the number of patients was wholly in the months of August and September, when the admissions amounted to 128, the Gentlemen admitted Members on Friday, May 28th, 1847:-D. Badcock; J. R. Lane; C. R. Durell; J. T. Clover; T. S. Collier; T. Rhys; L. Clarke; W. Pritchard; J. A. Simons; R. Davies; J. C. Inglis ;' B. Daniel. SOCIETY OF APOTHECARIES. Gentlemen admitted Licentiates, Thursday, May 13th:-William Thomas Gaye, Minehead; Joseph monthly average of the preceding ten months being Charlbury; Richard Dechamp Ball, Plymouth; Joseph Delves, Tunbridge Wells; James Lewis Holloway, 30.5, or nearly that of the winter season. The following table shews the ages of the patients and the mortality at each decennial period : Williams, Williton, Somerset; William Watts, junior, Gentlemen admitted Licentiates, Thursday, May OBITUARY. Died, May 11th, aged 58, at Paris, from malignant remittent fever, M. Lisfranc, Surgeon-in-Chief of the Hôpital la Pitié. M. Lisfranc was a member of the Royal Academy of Medicine, and a Knight of the Legion of Honour. May 11th, at Bath, aged 35, Joseph Channing Pearce, Esq., M.R.C.S., F.G.S., &c. May 16th, at Mohill, of typhus fever, Henry Soden, M.D., Medical Attendant of the Union Workhouse. May 17th, in Regent Street, John Phillips Potter, Esq., Assistant Surgeon to University College Hospital, and Assistant Demonstrator at University College. Mr. Potter died from the effects of a puncture received during a post-mortem examination. May 25th, at Worcester, Thomas Taylor, Esq., Surgeon, of Kidderminster, a Member of the Provincial Medical and Surgical Association. PROVINCIAL MEDICAL AND SURGICAL ASSOCIATION. ANNIVERSARY MEETING, The Anniversary Meeting of the Provincial Medical and Surgical Association is appointed to take place at Derby, on Wednesday, August 4th, and Thursday, August 5th. ROBERT J. N. STREETEN, Secretary. YORKSHIRE BRANCH MEETING. The Annual Meeting of the Yorkshire Branch of the Association will be held at the Cutlers' Hall, Sheffield, on Thursday, June 10th, at twelve o'clock. Lately, at Berlin, aged 55, Professor Wagner, of Members of the Association, or of the profession, who that University. are not members of the Branch, may be admitted as visitors on the introduction of a member. Any communication connected with the meeting should be made to the Secretary, Mr. Husband, York. COUNCIL PRIZE. The Committee appointed at Norwich for the management of the Council Fund for the present year beg to announce that THE COUNCIL PRIZE of £50 will be given for the best Report "On the Cerebral Affections of Infancy." The prize is open to general competition; the papers to be sent in to the Secretary of the Committee, Dr. Streeten, Worcester, on or before the 31st of May, 1818, each paper to have a motto affixed, and to be accompanied by a sealed envelope, bearing the same motto, and inclosing the name of the author. 34.84 INCHES. 29.967 30.43 3rd 31st . 29.47 .96 .67 2.31 Evaporation Prevailing Wind, North-East. BOOK RECEIVED. An Account of the late Epidemic Scarlatina, in Newcastle and its Neighbourhood. By Edward Charlton, M.D., Edin., Physician to the Gateshead Dispensary, Lecturer on the Practice of Physic in the Newcastle-on-Tyne Medical School, &c., &c. Newcastle-upon-Tyne: Richardson. 1847. 8vo. pp. 62. TO CORRESPONDENTS. Communications have been received from Mr. J. F. It is requested that all letters and communications be sent to Dr. Streeten, Foregate Street, Worcester. Parcels and books for review, may be addressed to the Editor of the Provincial Medical and Surgical Journal, care of Mr. Churchill, Princes Street, Sohc. |