barbarous a procedure, which, according to the present of distortion of the pelvis relatively to the size of the recognized principles of practice, is so unconditionally child's head, and likewise the condition of the maternal and so unhesitatingly performed. It is not, however, organic structures. Can we, then, measure with such my present intention to enter on the consideration of mathematical accuracy the pelvic diameters, as to such important questions, as the precise position which decidedly pronounce that the head of the child in craniotomy should hold in obstetrics, and what other utero will pass through unopened. If, after turning means should be employed; my views upon the treat- and extracting the body of the child, we cannot bring ment of labours protracted by distortions of the pelvis, the head through the brim of the pelvis, we shall be are already known to many of the profession. It compelled to use the perforator, which will now be cannot be a matter of surprize that I should (enter- attended by increased difficulty and danger, after taining opinions that craniotomy ought to be considered having already exposed maternal structures to great an operation of necessity, and not of election,) hail with hazard, by an unwarrantable operation. Perforation delight any measure which only promises to lessen the of the head of the child can be more safely and more number of these destructive operations. easily performed, when it lies over, or partly within, the brim of the pelvis, than when the cavity is occupied by the body, as it is in footling cases. Is there not great danger of fallacy in computing the admeasurement of a distorted pelvis? From my own experience, I am fully convinced there is, I mean, relative measure will briefly mention a case which strikingly corroborates the foregoing remarks:— Velpeau is the first writer who has practised turning the child in cases of labour protracted by distortion of the pelvis. He says-" Lorsque il n'y a qu'un des diamétres obliques de vicie, il en résulte ordinairement une disposition fort importante à noter. Si c'est à droite, par exemple, comme l'a vu Smeliie et comme Steinment, especially when slight distortion only exists. I en donne plusieurs figures, qu'existe le ressrerement, le côté gauche, pourra présenter une excès d'amplitude. Dans ce cas, si la tête vient l'occiput à droite, l'accouche. ment exigera presque nécessairement des secours, tandis que s'il s'etait présenté a gauche, la nature aurait pu se suffire à elle meme. Cette remarque indique assez que pour rendre l' accouchement facile chez une femme ainsi conformée, il suffit d'opérer la version, et d'amener le fœtus en premiére ou seconde position des pieds; de telle sorte que l'occiput puisse correspondre au côté le plus large au détroit. Elle explique aussi comment la même femme, étant accouchée spontanément une première fois, ne pourra peut ètre le faire sans la symphyseotomie ou la section Cesarienne á la seconde, et vice versá. En 1825, je fus prié de donner des soins à une femme que etait en travail depuis deux jours. La tête ne s'engageait point. J'allai chercher les pieds, et je terminai l'accouchement. En 1826, la même personne fut amenée a l'Hôpital de la Faculté etant en travail depuis quatre jours. Les eaux étaient écoulées et la tête fortement engagée. La matrice, très exactement appliqueé sur le foetus, ne permit pas d'operer la version. L'application du forceps fut tenteé par Desormeaux, M. Deneux et moi; mais rien ne put faire descendre la tête. La cephalatomia devint indispensable. Cette femme, enceinte de nouveau en 1827, m'a fait prévenir bonne heure lors du travail. Je suis allé chercher les pieds, et tout s'est promptement et heureusement terminé. L'issue différente de ces trois accouchemens tient à ce que, dans un cas, le gros de la tête se présentant à droite, ou le bassin était fortement rétréci, ne pouvait franchir le détroit, tandis que dans l'autre, la version ayant ramene l'occiput à gauche où les dimensions naturelles étaient conservées, le passage de la tête, n'etaient plus impossible.-Tome premier, p. 38. Before we have recourse to turning the child to supersede craniotomy, or other instrumental means, we should be fully satisfied that we do not thereby create equal, if not greater, evils. The first question to be settled is, can we safely turn and deliver the child! Here is involved a due estimate of the degree Dr. Hamilton, late Professor of Midwifery at Edinburgh, induced in the same lady premature labour at the seventh month in several successive pregnancies, after having in a former case used the crochet. She was the wife of a Colonel, whose regiment was stationed at Manchester. Being pregnant, the opinion of my respected relative, Mr. Wood, was requested, who, after a careful examination, decided that no distortion existed, and advised her to let pregnancy proceed. She was naturally delivered at the full period after a labour of shorter duration than ordinary, and recovered well. The child was of average size and weight, and its head as large and as much ossified as is commonly the case. This case is valuable on two accounts,-as first it proves the most experienced practitioner may err in ascertaining the precise dimensions of the pelvis; and, secondly, as a caution, not to rely implicitly on a professor's opinion. Can we always deliver by turning? Certainly not. One of the cases mentioned by Velpeau illustrates this fully. It would be highly culpable to attempt turning with the passages undilated and undilatable, or when the liquor amnii has been some time discharged. Under either of these circumstances the child would perish. Does turning give the child a better chance than might be afforded by other measures! As regards the crotchet, the answer is plain; but the long forceps, in the great majority of cases of slight contraction of the pelvis, may be more advantageously had recourse to. Will the head pass through a less pelvic space when its base comes first, as in footling cases, than when the vertex presents! My opinion is, that it will not, unless such unwarrantable force is used as to risk the separation of the body from the head, leaving the latter in the uterus. TREACLE IN BURNS. It has been, however, said, that the neck of the child alive, or recently dead, is so strong, as to allow such a degree of force to be used, as to greatly compress the sides of the cranium; but such a procedure is at variance with all scientific views, and incompatible with the safety of both mother and child. Does the head elongate more readily upwards than downwards? If only the same degree of extractile force is used, it does not, and certainly not so safely to the child. But assuming that the child's head elongates as readily, if not more so, in footling cases, than in presentation of the vertex, we know that the fanis is subject to fatal compression in the former,-which danger is greatly increased in cases in which the child has been turned, on account of distortion of the maternal pelvis. Can the head of the child be adjusted and better adapted to pass through the widest portion of the brim of a distorted pelvis, by means of the leverage its body affords after it has been turned, than by any other means? Velpeau has great reliance on the advantages of turning in these cases; but unless all contingent circumstances are favourable for its performance, the operation is most certainly bazardous to both mother and child. ON THE EMPLOYMENT OF TREACLE IN BURNS. TO THE EDITOR OF THE PROVINCIAL MEDICAL AND SURGICAL JOURNAL. RESPECTED FRIEND,-Observing from a communication which appeared in the last number of the Provincial Medical and Surgical Journal, recommending the employment of treacle as a dressing to burns, that the practice is not generally known amongst the profession, I beg to lay before the medical public a few cases, out of many more, in which I have successfully treated burns and scalds with treacle. I remain, with much respect, HENRY PAYNE, M.D. Nottingham, 7th month, 8th, 1847. Mary Parr, aged 70, of sanguine temperament, stout, and of intemperate habits, whilst sitting alone reading a newspaper by candlelight, accidentally set fire to it, and before the flame could be extinguished, it had spread to her cap and dress, inflicting a severe burn on the head, neck, shoulders, back, and breasts, but most severely on the back, where the dress was entirely burned off, and the cuticle destroyed. For the first three days after the accident she had been attended by a surgeon who had ordered the application of olive oil, but finding that she gradually became worse, he had despaired of her recovery. On being called in, three days after the occurrence, 1 found her very weak. The burnt surface presented a 405 livid hue. Treacle was directed to be immediately spread on every part of the burn, and a covering of linen-rag to be. laid over it. The application was directed to be renewed at intervals of a few hours. A dose of mild aperient medicine and a saline mixture were prescribed. She was advised to live upon mild diet and diluents. Upon seeing ber next morning, she told me that she bad felt no pain since the treacle was first applied, that she felt quite comfortable, and had slept tolerably well. The burn now presented a healthy rose-red appearance, and continued to heal under the same treatment until the epidermis was restored, which took place in a few days after my first seeing her, Owing to great irritability of the nervous system in this patient, she was attacked with a sympathetic fever soon after the accident, which rendered my attendance necessary for a week or two after the burn had healed. It was successfully treated with saline medicines in camphor mixture, and occasional doses of opening medicine. I am informed that this unfortunate woman not many months after set fire to her clothes again in the same way, and before assistance arrived was so dreadfully burnt that she did not survive her injuries many hours. M. A. P, a female, aged 50, fell asleep in the day-time before the fire, near which a kettle of water had been placed, which, boiling over, the water fell on her foot, scalding the whole upper surface of it. This patient had received treatment for a fortnight previous to my seeing her, but not finding any benefit from it, she applied to me. Amongst the various remedies that had been tried at different times, were simple cerate and olive oil. The scald was now looking highly inflamed, and discharged much serous fluid. Her general health was good, and it was thought unnecessary to administer any medicine internally, nor even to restrict her diet. I ordered the other applications to be discontinued, and the scalded surface to be well covered with treacle, and which, being followed by the usual happy results, was the dressing to be repeated three times every day, continued for a few days; at the end of this time I was pleased to find the part quite healed, and my patient returned to her usual avocations. Edward Butler, a stout child, aged three years, was extensively scalded on the back, hips, and thighs, by falling backwards into a tub of boiling-hot water. I saw this patient soon after the accident, and directed treacle to be spread over the scalded surface without delay, and to be repeated according as the treacle became fluid and less adherent. As might have been expected, the pain in this case continued, though much abated, under the remedy, and he obtained intervals of perfect ease, and slept soundly at times, lying continually on his face and breast. On the second day he became feverish, and a mixture of Epsom salt and infusion of roses was accordingly prescribed, which had a favourable effect. The part was kept covered with treacle for three days, during which the wound had the usual healthy appearances, and was rapidly bealing, when, owing to intolerable itching having set in, the application of treacle was discontinued, and recourse had to sprinkling the part with flour, and applying distilled rose-water over that. Rose-water and flour were afterwards applied together in this way, which completed the cure at the end of a fortnight. heat, all of which have continued till now, with the exception of the swelling, which in a great measure disappeared on the application of a sinapism. Still, however, there is some swelling, accompanied by tenderness, both on deep pressure, and on pinching the skin, as well as an inability to speak above a whisper. She has lost flesh, occasionally feels faint, and sleeps badly. Has had slight dyspnoea ever since her throat has been bad, but there is no cough. There is no visible redness of the fauces. She vomited some yellow matter, with mucus, yesterday, at the mere sight of food; suffers from thirst; habitually neglects her bowels. The headache is severe and universal, and she complains very much of smarting, occasionally shooting, pain, extending down the back, with tender Remarks. For upwards of twenty years I have adopted the above mode of treatment in burns and scalds. In all such cases which come under my notice, I order the treacle to be applied pure on the injured surface, and at the natural temperature; folds of wellaired linen being laid over it, and the dressing allowed to remain for two or three hours at first, when the treacle will be found in a more fluid state, hot to the touch, and the rag saturated with it. The treacle is then applied in the same manner, but after the secondness along the whole length of the spine, even to the or third day of the burn, will not require renewing oftener than once or twice daily, and the treacle will now begin to preserve its usual consistence while in contact with the burnt or scalded surface. The time occupied in healing the burn is very much less than is the case when any other means are employed. On the whole I know of no remedy capable of exerting more beneficial effects in burns and scalds, however severe, than treacle; and I am fully persuaded that life might be saved in the most desperate cases by the timely and free application of this invaluable remedy. It acts by effectually excluding the air, and (as appears by the fact of the pain entirely abating, or greatly diminishing, as soon as it is applied,) by abstract ing the morbid heat from the part, and thus proving at once sedative, refrigerant, and healing. Hospital Reports. ST. PANCRAS DISPENSARY. CASES ILLUSTRATIVE OF THE CONDITION OF THE SYSTEM WHICH IS ACCOMPANIED By EDWARD BALLARD, M.D., Lond., Physician to (Continued from page 378.) CASE III.-HYSTERIA. G. C., residing in Somers Town, aged 20 years, by occupation a servant, has been out of a situation for the last four months, and has in consequence lived badly. She applied at the Dispensary on August 18th, 1846. Is naturally nervous, and of a very irritable temper. Has suffered from pain in her back ever since an attack of "inflammation in the left side of her chest," a year and a half ago, but it has been gradually becoming worse, especially during the last three months. She has always been subject to headaches, but they have been more severe during the last three weeks. Seven days ago, in consequence of getting her feet wet, as she believes, her throat began to swell, and she became hoarse, with much pain on swallowing, accompanied by alternate shivering and tip of the sacrum. There is some tenderness of the Aug. 21st. Her voice returned before the cupping was completed, and there is not the least hoarseness. remaining now; swallows readily, but the throat is still puffy and tender, and the breath short. States. to-day that she is subject to a very slight cough, which she did not think worth mentioning before, but without expectoration, and, for the last month or two, to a pain under the left breast on walking, which is relieved by pressure. Bowels freely relieved; pain in back the same, but the tenderness is confined to the upper half of the spine, and chiefly on left side. Catamenia disappeared yesterday. Omni nocte sum. Pil. Rhei. Co., gr. v. R. Bebeerinæ Sulph,, gr. v.; Extr. Gent, q. s.; pro pil, ter die sumend. 25th. Has been suffering from neuralgic pains, affecting left side of face and ear, which are tender. The shivering and heat are less troublesome, but the cough is more so, having acquired a belching character; has lost the pain in left breast, and the throat is less tender and full; otherwise the same. Pergat. To apply a sinapism every night along the spine for a quarter of an hour. 28th. Nothing amiss with the throat or face now, and the cough is much less troublesome. She has not vomited for two days. Pergat. 29th. Urine of this morning clear, with an abundant cloud-like deposit; specific gravity 1022; acid re-action. The deposit consists of octobedra, varying in size; some very large, and both separate and aggregated, along with a few mucus corpuscles. In the evening of this day she was suddenly seized with giddiness, and fell down, remaining unconscious for several hours, but was not convulsed. Sept. 1st. Has had severe shooting pains over the whole head, but the scalp is not tender; has not vomited any more, but the last two nights has eructated some very cold tasteless water, and has had loud borborygmi; sleeps badly at night; percussion and respiratory murmurs natural under the clavicles; bowels: do not act properly. Omitt. pil. Nocte maneq, capt. Palv. Ipecac. Co., gr. v. Co., gr. x. ST. PANCRAS DISPENSARY. 2nd. Urine cloudy, and containing an abundance of large octohedra, which on the 3rd had fallen in the form of a cloudy deposit; re-action acid; specific gravity, 1014. 407 Meridie sumat Pil. Rhei in this class of complaints. As respects the urine, we have another example of the disappearance of the oxalate of lime on the full establishment of the catamenial flow, and also of the occurrence of the circular form of that salt. The effects of the recent cold under which the patient suffered were modified by the highly nervous condition in which it found her, the nervous symptoms prevailing over the vascular. CASE IV.-HYSTERIA. 4th. Complains of pain in both iliac regions, of a -shooting character, with tenderness, both superficial and deep. Bowels more regular, but the eructations continue; spinal tenderness the same. Has not used the sinapisms for some days. To re commence use of sinapisms. Auge. Pulv. Ipecac. Co., ad gr. viij. 8th. No improvement. Auge Pulv. Ipecac. Co ad gr. xij. 11th. Diarrhoea, with griping, occurred suddenly on the evening of the 8th, and has continued till to-day; the watery eructations, however, have ceased. Pain has been gradually coming on in the left shoulder, especially along the edge of the trapezius, and it is accompanied by tenderness. Catamenia appeared this morning. Urine of this morning is full coloured, of specific gravity 1013, and presents a rather dense deposit, containing an abundance of octohedra, and some crystals of uric acid. Omitt. Medic. To continue the sinapisms. 15th. Feels better, and appears more cheerful; very slight tenderness remaining in right iliac region; spinal tenderness distinctly less; catamenia very abundant. Urine of this morning acid; specific gravity, 1021; contains no oxalates, and only a slight mucous cloud at the bottom. 1 18th. Catamenia disappeared yesterday; has not headache, cough, or iliac pain, vomiting, eructation, or pain in the back; there is slight tenderness only in the lumbar and cervical regions; urine of about natural tint, of specific gravity 1019, acid; it threw down, on standing, a moderate cloud-like deposit, containing no octohedra, but some circular thin plates, some entire, and others broken. 22nd. Was seized on the 19th, in the afternoon, with headache and bilious vomiting; vomits now whatever she takes; feels more low spirited; bowels confined. Has had a return of pain in the left shoulder; tenderness and pain in lumbar region of spine only, and there is tenderness of the scalp. Urine acid; specific gravity, 1021; contains an abundance of octobedra. Pil. Rhei. Co., gr. x., omni mane sumend. 29th. Bowels have been freely opened daily, and the vomiting, and pain in shoulder soon ceased; has only slight pain now at the lower part of the back, and the tenderness is confined to this part also; still, however, she suffers from headache, and the scalp is tender. Discharged. Remarks. Whether we are to believe that this person ever suffered from inflammation within the chest, or whether, as is more probable, the illness which she thus designated, was merely a pleurodynia, she has ever since that time been out of health, and when she came under my notice was the subject of hysteria and spinal irritation. The influence exerted upon the symptoms of disease by the condition of the bowels, and occurrence of the catamenia, is deserving of remark, since it is one which is constantly illustrated T. F., aged 28 years, married, and of nervous temperament, has for the last two years been subject to close confinement as an assistant in a linen-draper's shop. Has in no way been intemperate in his habits. For the last eight months has lived badly, and during the last two still worse, in consequence of being cut of employment. He applied at the dispensary on the 19th of August, 1846. His illness commenced twelve months ago, by a sudden attack of diarrhoea, which weakened him considerably, and was followed even as he gained his strength by a sense of languor in the evenings, which gradually occurred earlier in the day, He was better in the winter, but at the commencement of the present summer began to feel nervous, and suffered from headache and diarrhoea after taking food. Soon after leaving his situation he began to experience watery eructations, and lately has found that he passed an inordinate quantity of urine, and has suffered from pain and a sense of burning in the left side. He is now pale, and the skin is disposed to perspire very readily. He states that he is extremely low spirited, frequently gives way to tears, and is readily alarmed, having become very timid, especially when alone at night. This timidity is accompanied by the hysteric globus. He has constant sense of weight at the top of the head, and a few days ago after a strong mental shock, laboured under the delusion that there were several persons in the room talking with him. Suffers from palpitation on the least exertion. He complains of an alternate sense of burning and throbbing, but sometimes sharp, pain in the left hypochondrium, with tenderness at the epigastrium and over all the left side of the abdomen, even on pinching the skin; there are no eructations now, but occasional borborygmi; lives now chiefly on bread and butter, and states that meat gives rise to a sense of epigastric weight. His bowels are irregular, at one time constipated, at another purged, and the food he takes sometimes occasions diarrhoea. The pulse is weak; tongue pale, flabby, rather tremulous, indented at the edges, covered with slight white fur, and watery. He complains of an aching pain in the loins, sometimes shooting round the abdomen, but chiefly to the left side; tenderness over spine, and especially on the left side of it, from the lower dorsal vertebra to the sacrum, pressure in this situation giving rise to a shooting pain over the left side of the abdomen. Urine exessively abundant and passed in large quantities every two hours; it was clear, acid, and on standing for thirty hours, deposited a slight cloud, consisting of aggregated minute fermentation globules, numerous small octoliedra, with a few crystals of uric acid; the specific gravity was 1009; no albumen; Trommer's test gave no indication of sugar. Ordered Bebeerinæ Sulph., gr. v.; Extr. Gent., q. s., pro pil. ter die sumend. more emphatically still a state or condition characterized by an exaggeration of the nervous phenomena of health or disease, whether these be exhibited in the mental condition of the patient, his sensations, or movements. Timidity, inequality of temper, a disposition to sudden manifestations of grief or joy-often on the most trivial grounds,-an agitated manner, temporary illusions of the special senses, spinal irrita 24th. No improvement in his general symptoms up to this time. Oxalates disappeared from the urine. 26th. Has been able to obtain some meat the last two days; rode as far as Finchley yesterday, and was less nervous all the day. Urine of last twenty-four hours, five pints, acid, pale, of specific gravity 1015; on|tion, shifting pains and tenderness in various parts of standing thirty hours a slight cloud formed at the bottom, with minute dark points in it, which were found to be crystals of uric acid, while the cloud consisted of fermentation globules as before, with a very few, and those small, octohedra. 28th. Had some beef for dinner on the 26th, which did not agree with him, and he has not been so well since. Urine four pints in the last twenty-four hours, extremely pale, acid, of specific gravity 1002, containing abundance of globules as before, with vibriones and an occasional minute octohedron. Milk diet. 31st. Has taken bread and milk and finds it agree very well with him; he suffers no sense of weight after it. Rode to Hampstead yesterday, and felt much | better afterwards, having lost his headache and the burning sensation in the side. Urine of the last twenty. four hours not quite four pints, slightly cloudy, with a slight cloud-like deposit, acid, of specific gravity 1016; deposit contains a considerable number of small octohedra and some crystals of uric acid. Contin. pil. Capiat Pulv. Ipecac. Co., gr. v., nocte maneque. September 3rd. On the evening of 31st, in consequence of some mental annoyance, was seized with severe retching and violent headache, but both are now less; still complains of globus. Urine of last twentyfour hours three pints, clear, with a very slight cloud at the bottom, consisting of octohehra, acid, of specific gravity 1017. Admitted into University College Hospital. Contin. Pulv. Ipecac. Co. 9th. Has been in every respect improving since his admission into the hospital, and has been free from beadache the last few days, since his diet has been improved. Sleep is defective. There is some tenderness over one or two of the upper dorsal vertebræ. Urine of specific gravity 1021; deposit as before, containing an occasional small octohedron. Contin. Pulv. Ipecac., Co. R. Ammon. Sesquicarb., gr. iv.; Inf. Gent. oz j.; Aq. Menth. Pip., oz. ss. Fiat haust. ter die sumend. A pint of porter daily. From this time his health regularly improved. He slept better, and in a short time began to gain flesh and strength; his urine was occasionally examined but no oxalates could be discovered in it. Tincture of sesquichloride of iron was prescribed, and he was discharged on the 10th of October. There is reason to beliere that during the latter part of his stay in the hospital he was very much exaggerating his complaints. Remarks. Although satisfactory instances have been recorded of paroxysmal hysteria in the male, such occurrences are to be regarded as amongst those rare phenomena which few are likely to meet with in the course of their professional career. Hysteria, however, is not a disease of paroxysms alone; it is the body, excessive excito-motory phenomena palpita.* tion, hysterical globus, hydruria, &c., are amongst the most prominent indications of the hysterical constitu-' tion; and it is by the presence of a greater or less' number of these that we recognize the affection, not only when it occurs in the female, but also when we' meet with it in the male. By comparing the above case with this hasty and imperfect outline we shall readily' recognize its principal features. The cause of the disease was, as usual in males, the combination of unpleasant and painful emotions and mental anxiety, with debility, resulting in this instance from close confinement to business and imperfect nourishment. Specific gravity 1002, is the lowest density of urine in which I have noticed the presence of oxalate of lime. The octohedra disappeared as the patient's strength was restored by a proper diet, and as the nervous excitement under which he laboured was abated by the use of opium, and the removal of irritating causes. CASE V.-HYSTERIA. T. V, aged 55 years, residing in a healthy part of the city, of a cheerful disposition when in health, married, and of temperate habits, applied at the dispensary on the 22nd of September, 1846, in consequence of having become "extremely nervous," timid, and low-spirited. When young he served on board one of the East India Company's ships, and when he left the sea he was engaged to copy law deeds. Four years ago he had a fit, during which he entirely lost his consciousness for half an hour, and it was preceded by a sense of lowness and giddiness. Ever since that time he has become weaker, and has fretted a great deal on account of inability to obtain employment. A twelvemonth ago he lost one of his sons suddenly, which made a great impression on his mind, and during the last few weeks has felt still more annoyed by one of his daughters entering a convent contrary to his wishes. Very shortly after this last occurrence, nearly six weeks ago, he began to lose his appetite, and to become much more nervous than ever he was before, becoming startled at the slightest noise, if sudden, and at such times suffering from palpitation. At the same time, he began to feel very languid, and low-spirited, and is now frequently disposed to shed tears, an inclination which, though he rarely gives way to it, yet he finds daily growing upon him. He is most low.spirited in the mornings, and sometimes is as cheerful as usual for the space of an hour or two; he has distinctly lost flesh during the last six weeks; he complains of pain, of a shooting character, in the temples, especially in the left, where it is accompanied by tenderness; his sight is dim, and frequently he has a sense of stars floating |