is repeated two or three times during the day. As the disease makes progress, the nasal discharge becomes more sanious, and irritating, causing ulcerations and Assures of the ale nasi and upper lip, which are We are told that cold air antagonizes consumption, alone or mixed with mucus. The sanguineous discharge - because there is no consumption in Russia. That damp marshy air also antagonizes consumption, because there is no consumption in ague districts. (?) That damp air is always warm. (?) And that the benefit of warm air is due to its moisture, and not to its tem. perature, (?) The simple English of which is this: the numerous non specific eruptions of the same parts That a cold damp atmosphere ought to be the most favourable to the prevention and cure of phthisis! We shall not pursue the analysis further. The whole book is pervaded by a spirit of which we cannot approve, and which when connected with frequent inaccuracies, and the absence of any real information, leads us to wish most sincerely, for the sake of the writer, and of the profession to which he belongs, that the desire of authorship had not in this instance been gratified. Foreign Department. ABSTRACT OF A MEMOIR ON INFANTILE SYPHILIS. By M. TROUSSEAU. (Translated for the Provincial Medical and Surgical Journal.) Constitutional syphilis seldom declares itself in the infant at birth, and is still more rarely seen to have commenced during intra-uterine existence. Nevertheless, some instances have been recorded of both occurrences. In the author's experience, the disease does not appear before the second week in life, which is the limit commonly assigned to it by authors. The other limit, or that at which constitutional syphilis ceases to manifest itself in the infant, is not so readily ascertained, but M. Trousseau has never seen it appear for the first time after the seventh month. Of course he alludes to secondary symptoms; tertiary symptoms in the infant, as in the adult, cannot be brought under any particular law. Constitutional syphilis does not always begin under the same form, hence any arrangement of symptoms according to any supposed order of appearance, must be futile. Sometimes it begins as a simple erythema, at others as a more deep-seated affection of the integument. Commonly, however, the disease first appears in the mucous membrane of the nostrils. Under such circumstances, the child is in that condition which has received the popular designation of the "snuffles." It breathes with some little difficulty, and the expiration is whistling when the mouth is shut. The disease is especially evident when the child is taking the breast; it is then, in fact, that we are able to measure the difficulty of breathing, because the child cannot then breathe freely by the mouth. At first the embarrassment is not greater than in some non-specific affectious, as at the commencement of measles, for instance; but this mild stage seldom lasts long, and symptoms of more significance arise, in some cases without the parents having taken any notice of the precursors. At this time a few drops of blood are seen to escape from the nostrils, either covered with a dark tenacious scab. This specific disease must not be confounded with which assail children at the breast. The latter do not necessarily commence in the nose, but sometimes extend to it from the mouth, or attack the nose, eyes, and ears simultaneously. The true venereal affection always commences in the nostril, and generally spends its force upon that part, having a tendency to spread inwardly rather than externally. At a still more roof of the nose falls in, giving the infant a strange advanced stage, the bones lose their support, and the aspect. The breathing becomes more difficult and snuffling, and sucking is almost impossible. If the child attempts to take the breast, it is obliged to drop the nipple from a feeling of impending suffocation. The time required for the disease to arrive at this stage is very various; sometimes a week or two is sufficient, in other cases many months are required. The mucous membrane at first appears thickened, and more or less softened, of a reddish brown colour, but without any trace of ulceration. Later, numerous small ulcers of variable depth are seen. In some cases these extend to the bones, producing caries and destruction of the vomer, the turbinated bones, and even in some instances, of the superior maxilla. In the more uncommon cases, we observe the lesions to have a scrofulous aspect; the septum narium is perforated, and the perpendicular plate of the ethmoid is converted into a semi-cartilaginous tissue. The connection of these lesions with the symptoms above enumerated is readily comprehended. Such is the origin, progress, and consequences, of syphilitic coryza. It is one of the most constant of the constitutional manifestations of venereal disease; “It gives rise to discharges, at first mucous, afterwards sanious and purulent, together with more or less bleeding from the nostrils. It ends by caries of the bones, and deformity of the features. ›› Another appearance in infantile syphilis, which is almost as constant, is the peculiar tint of the integuments. The disease, in fact, induces a gradual wasting of the child,—a cachectic condition, in which two periods may be distinguished. The first of these is the initiatory stage, which is essential to the disease, but which cannot be attributed to the mere length of its duration; the other is final, and generally is the near precursor of death. From the earliest manifestations of the venereal taint, even before the health suffers, the infant has a peculiar aspect. The skin, especially that of the face, loses its transparency; it becomes sallow, without puffiness; its pink hue disappears, and is replaced by a brownish tint. This colouration is rarely absent, though it varies in degree, and in the date of its appearance. Sometimes it is general; at others it is confined to the face, or to portions of it, as the forehead ACADEMIE DE MEDECINE, PARIS. root of the nose, eye-browe, and prominent parts of the cheek; the deeper parts in the bottom of the eye generally escape. The intensity of this colour is sometimes so deep, as to resemble ephelides. The time at which it appears is not easily ascertained, since little or no reliance is to be placed upon the history afforded by the mother. It is readily dissipated under treatment... 665 mucous membranes. The fissures are deep and wide, We have given the two above phenomena with some detail, because they are of great importance; because they are the first to appear, and are, moreover, closely allied to the next, in the series of constitutional symp-neighbourhood; they are later in their appearance toms, viz., the cutaneous eruptions. Almost all the types of skin disease are represented in the venereal eruptions of children, as in the adult; but some are of so rare occurrence, and when present are so indeterminate as to their specific nature, that they need scarcely be mentioned. Others, however, deserve a serious attention. After having examined a great number of cases, we do not hesitate to say that there are many forms of eruption of which it is very difficult to ascertain the venereal origin from their aspect alone; and we have frequently asked ourselves the question, whether there are any general signs by which the specific nature of an eruption can be determined? Can the same confidence be placed in the coppery tint, brown crusts, and circular forms of the eruption in the infant, as in the adult? Although it is sometimes very manifest, the coppery hue is often far from being so; in general it may be said that in robust well-fed infants, it is little apparent; and these frequently do not present the smoky complexion which has been alluded to. Moreover, certain forms of secondary erruption are never coppery, as the mucous tubercle for instance. The ulcerations of the mucous membranes, those of the nasal fossæ in particular, are of a colour sufficiently marked to prevent mistake, but unfortunately their characters are not ascertained until after death. ulcers of the throat and mouth are simply red or whitish. The When scabs form on the surface of syphilitic ulcerations, they are brown or nearly black. The latter colour is probably due to admixture with blood. than the coryza, coming usually simultaneously with the ochry tint of the face. These fissures are a source of great inconvenience; they give rise to great pain during the attempt to suck, so much so that some children refuse the breast altogether. The coryza adds to the severity of the symptoms by embarrassing the respiration. Under this accumulation of suffering the infant falls into a state of marasmus, the combined effects of the specific cachexia, and the inability to takė sufficient nourishment. (To be continued.) ABSTRACT OF THE PROCEEDINGS OF THE LITHOTOMY AND LITHOTRITY. M. Velpeau, who commenced the discussion, declared that he had never called in question absolutely the utility of lithotrity, he only wished to ascertain the exact limits of this utility. He conceded that in the cases indicated by M. Civiale, it was less dangerous than the ordinary operation; but, nevertheless, that fact was not indisputably shewn by statistics, for in order that such should be the case, there should be means of analysing, say at least a thousand cases, similarly situated in every respect. M. Velpeau, in continuation, The coppery tint is not equally perceptible at all stated that in the examination of M. Civiale's statisperiods of secondary disease. In the adult it is well tics, he (M. Velpeau) had been led to quite opposite The former, for instance, states that the known to become most distinct as the cicatrix forms, or conclusions. as the erythematous patches disappear. It is not so, relapses after lithotomy were more frequent than after. however, with infants; the cicatrices which succeed to lithotrity. M. Velpeau from the same figures deterall forms of eruption are reddish violet, and seldom mines the very opposite. He mentions also that M. assume the ochry hue. The livid hue is, however, in Civiale has omitted to include in the fatal or unsucmost cases, sufficiently distinctive. Such are the cessful cases, those in which death has followed the indefinite signs which authors have endeavoured to attempts to explore the bladder; but this he observes draw from the colour of the skin. The circularis not right, as it is not just to separate an operation direction of the patches does not merit particular from its natural consequences. It is not the incision was, that we are more ignorant of the circumstances | satisfactory conclusion. He examined first, the sta tistics of lithotomy, which he ascertained to exhibita mortality of one in four. He then took the statistics of lithotrity, and shewed that M. Civiale had given much too favourable a view, for taking the consequences of exploring the bladder into account, which he maintains should be done, he declared the mortality to be one in eight, instead of one in forty-three, as stated by M. Civiale. This, however, he declared to give so much advantage to lithotrity, that he himself would not be operated upon in another manner. under which lithotrity was useful, or even preferable to lithotomy; that the success of the operation has been greatly exaggerated, and under the circumstances in which lithotomy would fail, would be unsuccessful also, M. Amussat, who followed, held the opinion that lithotomy ought never to be adopted until after the trial and failure of lithotrity, unless special conditions existed which contraindicated it, such as a diseased state of the bladder or urethra, the latter of which is irremediable as far as to allow the introduction of instruments. After a careful attempt at breaking the stone, if it proves too hard, lithotomy must be had Tecourse to, but with this exception, lithotrity may be generally performed, even in cases of paralysis, or catarrh of the bladder. In conclusion, M. Amussat declares for the superior advantage of lithotrity, and considers that etherization much simplifies the operation. The speech of M. Segalas, which was the next in rotation, is of great length; so much so, that we can give but its salient points. The conditions which render lithotrity impossible, he says, are respectively those of the stone itself, the bladder, the urethra, and of the prostate. The stone may be too large, or too hard; ABSTRACT OF THE PROCEEDINGS OF THE M. Serres read his memoir on the treatment of fever by mercury, of which we have already given an account. M. Gonillon exhibited a new apparatus for fracture of the clavicle, which appears to be intricate without affording any particular advantages. M. Plouvier detailed his treatment of epilepsy, which consists in the exhibition of a combination of digitalis, belladonna, and indigo, in pills; cold baths, &c. (Continued from page 583.) SYMPTOMATIC AND SPECIFIC TREATMENT COMPARED. The practitioner that adopts an exclusive symptomatic treatment, is like the mariner, who, forgetful of his distant port, steers only to avoid the dangers which immediately beset him; whilst he who prescribes that his medicines may produce a specific effect alone, is like him who, blind to the rocks and shoals which obstruct his course, sails straight to the desired harbour. The one thinking only to clear the impediments with which he meets, sails away from his baven; whilst the other, intent only upon reaching it, is shipwrecked in his course. But as the skilful navigator, with his eye fixed upon his distant home, steers his vessel clear of the intervening impediments; so will the able prescriber, whilst he directs his remedies with a specific intent to the first cause of disease, attend also to the symptoms which it has secondarily produced. but a plurality of calculi is no impediment. Hardness NOTES FROM A PRACTITIONER'S DAY BOOK. is seldom an obstacle to the operation. Some, as the phosphate of lime calculi, yield almost to simple pressure. The bladder can only impede the operation by its great eontractility, and in this case the stone may be destroyed if it be small. Moreover, this exaggerated contraction of the viscus is usually a temporary phenomenon. A want of action in the coats of the bladder is still less of an obstacle, and is only prejudicial in requiring a more careful removal of the detritus. The existence of pouches in the bladder are a serious impediment to lithority. Inflammation and ulceration of the bladder are contra-indications, only inasmuch as the great sensibility of the bladder leads to forcible contraction of its coats. The diseases and obstructions of the urethra are only temporarily contraindicatory of the operation. Diseases of the kidneys do not interfere with the mechanical part of the operation, and are equally an objection to lithotomy. As regards the volume of the stone, M. Segalas considers that all small and middle-sized ones (ie., not surpassing in diameter ten lines,) ought to be litho tritized; of large stones also, the phosphates may be broken down. Uric acid calculi cannot be so satisfactorily managed. The number of the calculi is, according to M. Segalas, no argument against lithotrity, provided they are not large at the same time. M. Blandin agreed with M. Velpeau, in placing little or no confidence in M. Civiale's statistics. This surgeon had stated that lithotrity did not irritate the bladder, and that relapses were less frequent than under lithotomy. This M. Blandin refused to acknowledge. The speech of M. Malgaigne appears to have excited much attention. He strongly insisted upon the necessity of accurate statistics, without which he stated that it would be impossible to arrive at any BITARTRATE OF POTASS IN ALBUMINURIA. In that diseased condition of the general system which has been denominated albuminuria, not only does albumen exist in the urine, but it is found in the fluid which fills the interstices of the areolar tissue, and accumulates in the cavities of the serous membranes, whilst an undue quantity exists even in the serum of the blood itself. Now, in this disease I have seen the most decided benefit follow the daily administration of cream of tartar in purgative doses; patients under this treatment have gradually become less anasarcous, and by a sufficient continuance of the remedy, the albumen has, for a time at least, ceased to appear in the urine. How can we explain this effect? The experiments of Poisseuille have proved that the purgative action of certain neutral salts depends upon their attracting to them, by endosmosis through the tissues, the serous NOTES FROM A PRACTITIONER'S DAY BOOK. part of the circulating fluid, and the liquid evacuations produced by a saline purgative, are found to contain a large quantity of albumen. If, then, the albuminous fluid is carried off by the bowels, it ceases to accumulate in the areolar tissues, and the serous cavities, and is no longer excreted by the kidneys. EXCESSIVE CUTANEOUS SENSIBILITY PRECEDING AND 667 bowels torpid. These pains, however, had no resemblance to those which occur so frequently in the hysteric constitution, and they were entirely confined to the cutaneous textures. A healthy active old gentleman, of about sixty-five, sought my advice concerning a pain round the right side of the chest. He had suffered, he told me, some months before from an eruption, and this pain had remained in the part ever since. It was described as of a smarting, burning, shooting, and itching character, and extended from the median line behind, to a point in front of the nipple before. These sensations were almost constant, and usually kept him awake for some A healthy-looking country-woman consulted me about a pain accompanied with excessive itching and smarting round one side of the back and chest. The parts were extremely tender, but presented no redness or other abnormal appearance. I tried a variety of local and constitutional treatment without any advan-hours at the beginning of the night; but when once tage. At length a rather severe eruption of herpes zoster made its appearance, and on the subsidence of this the pains ceased. A gonty old farrier, with a broken constitution, suffered from an attack of herpes round one side of the loins and the lower part of the abdomen and groin. The eruption, though of more than ordinary severity, soon yielded to appropriate treatment, but the pain remained in a very severe degree for many months afterwards, causing great and constant suffering. He described it as a combination of the sensations of burning, tingling, itching, and smarting, and at one visit said: "I feel at this moment as if a number of dogs were gnawing away at my side." The eruption had left some copper-coloured stains in the situation of the patches, and here and there a solitary papilla seemed somewhat enlarged, but there was no other abnormal change. All the local sedatives I used only increased his torment; a belladonna plaster and an His appetite and general health were better than they rested well. A young woman presented herself to me for advice about an abrasion of the skin, caused by the rubbing of her dress. She told me that three years before, she❘ had suffered from the shingles round the right side of her abdomen and loins, and that ever since this time the parts had been affected with pains of a burning, cutting, and smarting character. They were not constant, but were excited by the slightest irritation or change of temperature. She generally suffered most when she dressed or undressed, and could never at any time bear her clothes in the least degree tight. Independently of these pains, her health was much deranged; the menstrual functions were much disordered, and the asleep they rarely disturbed him, though they returned as soon as he arose in the morning. Every movement of the body or limbs increased the pain: whenever he raised his arm, he felt the movement in his side; whenever he put his right foot to the ground, it quite jarred the painful part. Moderate pressure, however, relieved his sufferings, and after lying for some time upon the painful side, it became tolerably easy, whilst at night he was always obliged to adopt this posture before he could get any sleep. As he lay talking to me on the sofa, I could observe the old gentleman pressing his side for relief against the pillow on which he was reclining. An examination of the part showed no abnormal appearance with the exception of some reddish brown stains of the skin. They resembled. those which are left after herpes zoster, when the vesicles have been ruptured, and, moreover, terminated behind exactly at the median line. There was no tenderness on pressure, but the skin he said felt sore, and my manipulations greatly increased the annoying sensations. The thoracic cavity emitted no dull sound on percussion, and the respiratory murmur was everywhere distinctly audible. His health at the time of the eruption was much deranged, but now he felt as well as usual, and I could in fact find nothing to be rectified by prescription. I directed a linimentum opii to be rubbed on the chest every night at bed-time, and as he thought, after a few days, that he had derived some benefit from the application, I advised its use also in the morning. The evening friction he considered relieved the pain, but by that in the morning it was decidedly aggravated. Another examination deciding me in the opinion that the pain was of a nervous character, I determined upon using counter-irritation. To the right of the spinal column over a space three inches in width, and corresponding to about eight of the dorsal vertebræ, I applied the glacial acetic acid with a camel's-hair paint-brush. Finding the skin not very sensitive of the irritant I used it freely, charging the brush several successive times with the acid. Two days afterwards he was complaining a good deal of the application, but the former pains were easier, and in a week he suffered from them only in the most trifling degree, and as they continued to get better, he declined any repetition of the treatment. C. ARNECAPLE. (To be continued.) POOR LAW MEDICAL RELIEF. [The subjoined circular has been issued to the Medical Officers of Unions by the Committee formed at the late meeting.] Committee Rooms, 4, Hanover Square. 22nd November, 1847. The Committee of the Poor Law Medical Officers submit to you the enclosed return; and they beg the favour of you to fill it up, and return it to them with the least possible delay. In order to support the representations which they are about to make to the government, they feel it necessary to be in possession of the most full and accurate information as to the preseet state of medical relief throughout the country; and the only means of arriving at that information is, by the general trans General Retrospect. PATHOLOGICAL ANATOMY. CONGENITAL DEFICIENCY OF THE GALL-BLADDER. Mr. Canton relates the following rare case. In examining the body of a female aged 65, his attention was directed to the circumstance of the trifling exudation of bile upon the neighbouring intestines, and on raising the liver he discovered that the gall-bladder was absent, there being only a small indentation in the liver at its usual position. Suspecting malformation Mr. Canton searched for the viscus or its remains, but without success; and on making slices of the liver without finding traces of it he was convinced that it was congenitally deficient. The liver was small, the right and left hepatic ducts of their usual diameter, uniting at an obtuse angle just below the transverse fissure to form a ductus choledochus, which was the common mission to them of the enclosed return. Where medical officers have not attended their districts so long as for the last five years, it will be sufficient to make the return for the time only that they have hepatic duct, larger than usual and double its ordinary attended. Their attention is also particularly requested to the questions regarding the best mode of remunerating medical attendance on the poor. calibre. The lining membrane of this trunk resembled the mucous membrane of the gall-bladder. The cystic artery, vein and nerves, were wanting. In his comments upon the case, the author remarks upon the fact that the gall-bladder is often deficient in the lower animals; in mammalia, birds and fishes. He The committee beg also to remind you, that considerable expenses have been, and must be, incurred, in the prosecution of their enquiries; and they earnestly request, that you will forward a subscription, by also notices the occasional degeneration of the viscus post office order, or otherwise, to the treasurer, Thomas Martin, esq., Reigate. We are, On behalf of the Committee, Your's respectfully, THOMAS HODGKIN, M.D., Chairman. All communications should be addressed to the The questions submitted in the form of return are as follows: 1. District. 3. Population. 2. Union. 4. Acreage. 5. Total number of sick as per weekly return. 6. Number of sick attended but not included in weekly return. 7. Amount of annual salary, exclusive of extras. 8. Amount received for extras. from disease, which might lead to the idea of its absence in consequence of its conversion into fibrous tissue; the mistake is, however, rectified by the presence of the cystic artery and vein. The author further observes, that no specimen should be set down as one of congenital deficiency of the gall-bladder, until careful sections of the liver have been made, to ascertain whether or not it is situated in the substance of the latter viscus, either in a perfect, contracted, or condensed state, in other words, still occupying the position of the early fœtal period. Again, the condition of the cystic duct should be noted, and its presence even in the modified state referred to, would justify the inference that the gall-bladder had at some period been present, though imperfectly developed, and that from imperfection of function had gradually disappeared. That the case under consideration is rare, is acknowledged by Mr. Kiernan, who is justly regarded as a high authority in matters connected with the anatomy of 9. Payment for midwifery:-Rate per case. Amount the liver.-Lancet, October 16th. received. 10. What is your opinion as to the propriety of payment per case, and the amount? 11. What is your opinion as to a fixed salary, based on the number of cases attended, and the mileage? 12. What is your opinion as to payment for extra cases exclusively of midwifery ? 13. What is your opinion as to fixed payment founded on the number of population and area, to be settled by the Poor-Law Commissioners? PRACTICAL MEDICINE. INSANITY CURED BY THE USE OF THE TREPHINE. Dr. Robertson, resident physician to the Yarmouth Military Lunatic Asylum, has furnished us with the following instructive case: A sailor, aged 23, was admitted into the Cumberland Lunatic Asylum, February 10, 1845. Ten years prior he fell from the mast of a ship, which accident was followed by an attack of acute mania, In six weeks The returns to embrace the five years ending Lady he recovered his intellectual faculties, but continued Day 1847. so ungovernable in his temper and violent in his conduct, as to render him unfit to be at large, and to necessitate his removal to the Asylum. On admission he complained of frequent pains in |