The diagnosis being established, the prognosis is but too unquestionably gloomy. The only possible chance for the patient is from operation, and that can give scarcely a shadow of hope. In the immense majority of the cases of pneumo-thorax, the air has escaped from a tubercle or vomica bursting through the pulmonary pleura. Under such circumstances we operate for pneumothorax only to leave phthisis behind, a melancholy prospect for patient and practitioner. Still there is a period and a combination of circumstances, when paracentesis thoracis may not only be strictly justifiable, but absolutely called for. If the effusion has increased to so great a degree that the patient is in danger of suffocation, as was Mr. Cornish, we conceive that the physician must throw these ultimate considerations overboard, and neglect remote evils to administer present relief. The operation is a trifling one per se, its immediate consequences are very seldom fatal, the sufferings for which it is performed dreadful, the relief it affords both great and instantaneous. It must be remembered that pneumo-thorax is frequently produced by a tubercle giving way in a very early stage of phthisis: a stage which, if not susceptible of cure, is certainly far from being speedily fatal. In the case of Canning, to which we have alluded, there were comparatively few tubercles in the lungs, and in that of Mr. Cornish they were by no means abundant. On the whole, we should say that, in empyema, the operation is much more likely to succeed than in pneumo-thorax; in the former it may be curative-in the latter it is palliative only.

We find that we have not space for the cases of fungus hæmatodes, which we, therefore, defer until our next report. If the present has run to some length, we can only remark, in extenuation, that the subject is become one of extreme importance, and is ill understood in all its bearings by the mass of practitioners in this country. Our object, too, has been to impress on the minds of our readers the practical value of auscultation; and this being almost in its infancy here, we were necessarily

compelled to dilate on points, which, if generally comprehended, would require no explanation.

VIII.

WESTMINSTER HOSPITAL. I. CASE OF EXOSTOSIS TREATED WITH MERCURIAL FRICTION AND TURPEN

TINE.

ANN ROGERS, æt. 20, admitted July 15th, 1829, under Mr. Guthrie, with swellings on the shin-bone of the left leg-she is a tall and tolerably healthy looking woman, her face seems rather to express a scrophulous habit.

She states about four years ago she caught a very severe cold—she was menstruating at that period, and the cold affected her very violently-she had pains in her head and back, her whole body swelled and more particularly her legs, which pitted on pressure of the finger. She has never been quite well since that time-she is very positive in her assertion that she has never had any syphilitic affection. She is unmarried and lived as a servant. It nevertheless appears probable from collateral circumstances that there may have been some such cause for the swellings on her shin-bone. She suffers from continual pain down the tibia of the left leg, which increases in violence at night. It is about seven years since the catamenia commenced, and they have appeared at regular periods ever since. She attributes these swellings to having struck her leg against the stairs about the time when she first perceived them. She now complains of severe pain in the head and the shin of the left leg-pulse regular, 88 in the minute-tongue clean-bowels tolerably open.

B Hyd. Subm. gr. ij.

Pulv. Rhei, gr. xij. ft. pulv. bis in die sumend.

July 19th. For the last three nights three leeches have been applied on the swellings with some little benefit-Mr. Guthrie has ordered the following mixture.

but moved about with it supported by a suspensatory bandage-nor until a few days previous to his admission did he ever lay up.

About six weeks ago the skin appeared to be destroyed, and two or three small holes, were observed in the scrotum, discharging matter-he had a poultice applied, and the holes gradu ally united and formed one large ulcer, from whence a very copious and offensive discharge proceeded-it has continued in much the same state up to the present time. He has generally enjoyed good health, with the exception of repeated attacks of syphilis. And during the whole of the last nine months, in which the disease has been advancing, he has felt very well, and suffered but little pain from the diseased testicle, except lately, that he has experienced a twitching, prickly sensation in the lower extremity of that side. His appetite has been good, and he has followed his business, till within the last ten days he is pale, but not very unhealthy in appearance. His pulse is full, regular, and natural-bowels open; tongue clean.

Dec. 20. He continues his poultice, and suffers little pain.

Jan. 3. A powder, composed of equal parts of myrrh and lapis calaminaris, is ordered to be applied to the ulcerated surface daily.

10th. The appearance of the testicle is rather improved.

Feb. 10th. The powder has been applied daily, and the sore is much diminished in size-nearly one-half, it remains, however, much the same in character. General health unimpaired.

He continued in the same state until the 10th of April, when Mr. Harding proceeded to the operation for castration. A straight incision was made, which separated the chord from its sheath and divided it. In consequence of the adhesions produced by the disease, the testicle could not be separated from the scrotum, without the aid of the knife. Two arteries were taken up-and the hæmorrhage during the operation was very trifling-the edges were brought together with three sutures. About an hour after he had

been in bed-hæmorrhage came on, which could not be stopped without opening the wound, a large coagulum was then taken out of some ounces weight, and after a careful search, the cause of the hæmorrhage was found to be the arteria media scroti, very much enlarged. This was secured, and the bleeding entirely ceased. About a week after this there was considerable tendency to inflammation, which was relieved by leeches and cold lotion. The healing process then went on favorably and the patient left the hospital quite well.

III. CASE OF TRISMUS TRAUMATICUS, ARISING FROM DECAYED TEETH AND COLD.

Caroline Lewis, æt. 24, admitted Dec. 21, 1829, under Mr. Lynn, with her jaws firmly locked, complaining of great pain in her head and neck. It appears that the jaws closed suddenly one afternoon, (three days before her admission) and resisted all her efforts to open them. She had suffered from a cold for a fortnight before, which had swelled her face inside and out, accompanied with most violent tooth-ache. From her earliest recollection she has been troubled with frequent and severe attacks of tooth-ache, scarcely ever a month free. She menstruates regularly, but scantily. Two or three of her side teeth are, fortunately, reduced to mere stumps, so that she can swallow any liquid through the cavities they have left. Dec. 21st.

R. Hydr. Submur. gr. iv.
Pulv. Jalapæ. 3ss.

st. sumend.

mist

ad

Ft. pulv.

R. Liq. Ant Tart .... 3j. Liq. Ammon. Acet. Ziij. Mist. Camph. 3v. Ft. et cap. coch. iij. 4tis horis. V.S. xij. and fomentation to the checks.

....

22d. There is less fever, and also some slight abatement of pain in the head and face. Continue fomentation to the face and medicine.

23d. Much the same. Bowels freely opened.

R. Lin. Volatil. c. 3ij. pro fotu. Two eggs per diem.

24th. She was much the same all the morning, but complained of sickness. Towards evening it increased, and a violent fit of vomiting came on; she felt choking, when she felt a "crunching," attended with violent pain, and her mouth opened.

25th. She feels much better-pain in the face less.

28th. The glands on the right side of the neck are rather enlarged, and her face is not quite free from pain. On examining her mouth, the whole of her teeth, with the exception of the three or four front ones, are in a state of decay. Most of those that remain being merely blackened stumps; tongue tolerably clean; bowels confined.

Jan. 3d. Dismissed well. She refused to have any thing done to her teeth.

IX.

BIRMINGHAM EYE INFIRMARY.

MR. MIDDLEMORE, assistant-surgeon to this institution, has published, in the Midland Reporter, a quarterly report of the cases treated at the establishment during the last three months.* The great majority have consisted, of course, of the different varieties of ophthalmia, opacities of the cornea, iritis, amaurosis, and tinea. Appended to the numerical report are some observations on iritis and amaurosis, by Mr. Middlemore, which are deserving of attention.

I. IRITIS.

Mr. Middlemore has been experimenting with the spiritus terebinthinæ in this disease, and the results appear to be confirmatory of the observations of Mr. Carmichael and Mr. Guthrie. He has given it with great advantage to patients who, from delicacy or peculiarity of constitution, are unable to take mercury to the production of salivation. If, too, the acute symptoms have been relieved by mercury, but a chronic disorganizing inflammation remain, Mr.

Middlemore would strongly recommend the exhibition of a drachm of turpentine two or three times a day. He would urgently advise the early employment of turpentine in inflammation of the choroid and retina.

"Strumous iritis is a disease somewhat uniform in its appearance and history, obstinate in duration, and very little influenced by the modes of treatment usually recommended for its cure. The individuals most obnoxious to its attacks, are children, between the ages of six and eighteen, of a delicate constitution, fair complexion, light hair, and blue eyes; as soon as the disease has become established, the cornea assumes a misty appearance, patches of red vessels are frequently seen upon its edge; there is a zone of pink vessels around the cornea in various situations; the patient is troubled with profuse lachrymation, and great intolerance of light; the iris is almost inactive, and vision is considerably impaired; the eye-brow appears to project considerably before the eye; the muscles (if one eye only be affected,) become thicker and stronger than those of the opposite side, from their powerful contraction to exclude the light, and give to the countenance a distorted appearance; the pulse is generally quick and irritable; the appetite uncertain; the secretions unhealthy; the skin dry and harsh, but variable in temperature, the heat of the scalp being oppressively great, whilst the extremities are often chilled with cold. It would be trifling to enumerate the various plans of treatment recommended for the cure of this troublesome disease; no one plan' will succeed; a treatment directed to the circumstances of each particular case, will always be necessary; for a delicate child, I should advise small doses of the hydrargyrus c. creta every other morning; a grain of quinine twice a day; every other evening a warm bath, and should the skin be harsh and dry, notwithstanding its employment, friction with the hand, or a soft brush should be used, and on no account should suitable clothing, with a view to maintain

6

lected; a small issue in the arm; mo

derate (not fatiguing) exercise must not be omitted, and perhaps riding on horseback surpasses in excellence all other modes of taking it; without specifying any particular articles of diet, I may say in the general, that it should be of a light and nutritious character, animal food being allowed only every other day."

II. AMAUROSIS,

The following remarks are chiefly on the exhibition of strychnine in that formidable malady amaurosis. It is a remedy which is now in some vogue, not only with oculists but with physicians also, in the palsy-cases of middle and advanced age, whether the affection be of the retina or of one side of the body, of a solitary muscle or a large portion of the material frame. The very nature of these cases, we mean their connexion with advanced life, and their dependence on the wear and tear of the machine, precludes the hope of any remedy or class of remedies proving extensively and permanently useful. Medea's cauldron would suit such cases, but short of the youth-restoring drug of the enchantress, there is nothing, alas! that will again give elasticity to the withered sinew: plumpness and vigour to the wasted muscle; or the finely-tuned sensibilities of adolescence to the palsied nerve. Nevertheless, there are, undoubtedly, some cases of palsy and amaurosis, we fear they are fewer than is imagined, that are benefited by the exhibition of the strychnine or stimulating medicines of that class. The discrimination of these must be a matter of experiment and experience. We will give the results of Mr. Middlemore's.

"If a patient has overworked the eye by long-continued action, confined to the inspection of objects of the same colour and description, an enfeebled condition of retina (just as we produce an exhausted state of muscle by overexertion) will take place. If a man subject his eye to an unnatural stimulus, by looking for many hours daily at bright substances of the same or nearly the same colour-or to sudden transitions from an artificial glare to compa

rative darkness (as miners)—or to a diminished stimulus, as by working in dark rooms, or places imperfectly supplied with light-or to any cause allowing the visual textures of the eye to remain, for a long period, in a state of inactivity, as takes place where large opacities of the cornea, and fully-formed cataract exists, the power of the retina will be partially destroyed-its susceptibility to the stimulus of light diminished; but in none of these cases will there be found any structural change in the retina or the optic nerve, any congestion of vessels, or any discoverable alteration from a healthy and natural condition; nor will the system, in all probability, be found affected; no altered state of health sufficient to account for the dimness of vision, will be found to exist. At some kinds of employment it is necessary for the indivi-, dual to work with the head bent forwards, declining, or the body so distorted as to favour the too liberal flow to the eye, and retard its return; inducing what is termed congestion; a distended state of vessels, unfavourable to free and active circulation; a condition of eye which is also frequently induced by the investigation of minute objects by the aid of powerful glasses. Loss or diminution of the power of vision sometimes comes on from certain causes which diminish the vigour of the system generally-as for instance: after profuse salivation, long continued suckling, menorrhagia, &c. In all these cases, I believe, the strychnine is calculated to produce great and permanent advantage, in combination, of course, with other remedies suited to the particular exigencies of the casefor example: if the retina be weakened in consequence of diminished vigour of the system, remedies adapted to strengthen the system, and a removal of the cause enfeebling it, might be joined to the local application of the remedy in question. But the power of the retina will not always return with the returning strength of the system; in such cases the strychnine is singularly valuable, producing, with wonderful rapidity, the restoration of the organ of vision. Strychuine given inter、