nally does not produce the same beneficial effect upon the retina, as when applied externally. The mode of using it is already before the profession. After having tried it in a variety of ways, and in different situations, I have not been able to discover a better method than that of blistering the skin above the eye-brow, and, after having carefully removed the cuticle, sprinkle the powder upon the raw surface, taking care to pass a spatula upon the part so sprinkled, to secure it against removal and insure its absorption; a piece of linen (not greased) should afterwards be bound upon the part. The quantity with which I generally commence is the twelfth of a grain upon each side, daily augmenting the quantity, as the patient is enabled to bear it, until it amounts to the of a grain upon each blistered surface. Its first effects are slight pain in the head, increased power of vision, and severe smarting pain of the part upon which it is applied. Some patients cannot bear its application; others require great care, and a very gradual augmentation of the quantity to enable them to bear it; whilst others will admit of its application without experiencing any other uneasiness than what arises from its action upon the sore. It is not necessary, I presume, to detail cases in support of my views; such a plan would greatly extend my observations, which I have been studiously anxious to limit.-I will now, for a short time, draw the attention of your readers to those cases in which the employment of this remedy would be useless or injurious. If the amaurosis be dependent on any morbid condition of the brain any alteration of the bony structure; any tumour or other sub stance pressing upon the optic nerve, the effects of former inflammation, such as opake deposition or partial disorgan. ization, the effusion of blood or morbid growths, the enlargement of the vitreous or displacement of the crystalline humour, producing pressure upon the retina; a varicose state of vessels, as a consequence of distention so continued as to impair their tonic and elastic properties; inflammation of, or disease of, CASE OF ACUTE NEURALGIA RHEUMATICA OF THE DIAPHRAGM. By Dr. COUDRET, interne à L'Hôtel Dieu. This case is related by the patient himself, who, as a medical man, may well be considered as capable of appreciating the nature and seat of his own malady. Aged about 29 years, of nervous temperament, but enjoying good health, he had been subject, for some time, after exposure to cold in the amphitheatre, to slight, intercostal pain in the left side, occasionally exchanged for pains of a colicky nature in the bowels-for coryza-and for cynanche tonsillaris. On the 28th January 1830, when the temperature was 12° of Reamur below zero, he was imprudent enough to have his hair cut close, immediately after which he became affected with slight bronchitis and some inflammation of the tunica conjunctiva. On the 8th of February, these affections being still in existence, he was exposed, while warm, to a current of cold air, and thence repaired to the Hôtel Dieu, where he did not, at first, experience any particular inconvenience. At 5 o'clock in the afternoon, he dined, though not with appetite. At 8 o'clock, he experienced a febrile horripilation, general malaise, heaviness of head, pain in his joints, disin without bringing up any remains of food, or any bile. He now felt better, and had a mild perspiration. But the pain above-described continued, and the pyrexial symptoms were soon renewed, with discontinuance of the perspiration. Thirty-five leeches were now applied to the anus, followed by a hot poultice to the same, and also to the feet. These means completely re general malaise-the perspiration was reproduced-and he would have experienced some repose, had not the pains in the region of the diaphragm continued to harrass him incessantly. He now balanced between the application of 40 or 50 leeches to the chest, or sinapisms to the same part. He determined in favour of the latter-and managed them with great dexterity, contriving to keep up a constant counter-irritation over the left side and back of the thorax, without inducing vesication. Two days of this discipline gave complete relief to his sufferings. On the 12th of February, he was free from complaint excepting debility. clination to motion. Soon after this a shiver was felt, the coldness being succeeded by febrile re-action, violent pain in the limbs, the loins, and head, &c. The night was very restless, the pains, though general at first, being concentrated ultimately in the left lumbar region, and at the lower part of the chest on the same side. Next day, 9th February, the skin was still dry and burning the restlessness incessant moved the head-ache, and much of the head-ache intense-feeling of great sanguineous congestion about the face -tongue pasty, but not red-thirst considerable-some nausea-urine pale -bowels costive-cough, with catarrhal expectoration-the pain in the loins and side increased by the act of coughing. On percussion, the chest was every where sonorous. At each effort to inspire, the patient found himself checked by a sudden and violent pain, apparently in the situation where the diaphragm is attached to the false ribs of the left side, and also to the spine. He conceived that he felt this same pain in the tendinous centre of the diaphragm, whence it appeared to radiate along the course of the left diaphragmatic nerve to the neigbourhood of the clavicle of that side. The act of turning, the least effort to breathe, to expel the urine, to eructate, or blow his nose, increased this pain to exquisite torture. His common respiration was also short and embarrassed. Lastly, he felt a sensation in his left arm similar to what is described by those who labour under angina pectoris. Nothing was felt about the right side of the chest. Careful pressure was made on all parts of the abdomen, but no uneasiness was thereby produced. These phenomena convinced the patient that the disease was not pleuritis; but that the seat of the malady was the diaphragm. The fever was now very acute, the pulse full, hard, and quick-in short, every thing indicated the necessity of venesection. His friend, who was with him in the Hotel Dieu, immediately bled him to a large amount, without producing faintness. The blood was rich, but very little inflamed. Feeling some nausea, he took several glasses of warm water, and cleared his stomach, but The author thinks, and we are inclined to agree with him, that the phenomena which he has described, and severely felt, indicate a rheumatic affection of the diaphragm-a disease rarely delineated by medical writers, probably on account of the inability of non-medical patients to accurately ascertain the seat or kind of their own dolorous sensations.-JOURNAL COMPLÉMENTAIRE, II. CASES ILLUSTRATIVE OF THE EFFECTS A man about 35 years of age, of strong * Journ. Hebdom. No. 79. addressed by name, but was not able to answer questions. His face was injected, his hair on end, his eyes wild and haggard, his discourse incoherent. He had no stertor nor paralysis, and when his hand was raised was able to maintain it so. The abdomen free from tenderness, the pulse 75, regular but small, the skin moderately warm and dry. M. Recamier considered the affection as purely nervous, styled it nervous stupor, and prescribed affusions from head to foot of water at the temperature of 18° Reaumur. The delirium immediately ceased, and on the next day the patient was walking about the ward. M. Recamier, at least the reporter for him, enters into a subtle and lengthy disquisition on the modus operandi of the cold affusion in this and other cases. The pith of a page or two of verbiage is merely this, that the remedy acts on the nervous system, through the medium of the shock to the surface of the body. There is no great discovery in this. The best mode of making the affusion is to procure a vessel with a large mouth, from which the water, at the temperature of 18° Reaumur, is to be poured for the space of six minutes on the head of the patient standing in the bath. The mouth and nostrils should be protected, and it might be useful to place a large wet sponge on the head, by which means the water would run down over the body and produce much the same effect as the affusion. The reporter concludes the subject with a case of those anomalous hysterical symptoms which a bad practitioner will almost always mistake, a good one as generally recognize. Cough, slight hæmoptysis, palpitations, obstinate rejection of food, &c. were the symptoms that followed in succession or appeared in combination with each other, and obstinately resisted the antispasmodics and sedatives. The reporter, M. Dupré, then had recourse to the bath, the body being immersed in water of the temperature of 26° Reaumur, whilst affusions at 18 were directed on the head. This proceeding was adopted for 15 minutes at a time and with very good effect. All well-informed practitioners in this country are in the habit of using measures similar to the above, in nervous and hysterical disorders. The shower-bath is a less clumsy method of effecting cold affusion than the sponge or the pitcher, but under certain circumstances the latter may be more readily obtained. It is always a good precaution in commencing the use of the shower-bath, to let the patient stand with the feet in warm water, especially if she be a delicate and nervous girl. The benefit derived from this plan in chorea, and the nervous pains in the chest and abdomen of young women, is frequently considerable. III. SYNCOPE FROM HÆMORRHAGE. A woman, æt. 37, affected with organic disease of the uterus was about to have the organ extirpated by M. Recamier, when on the 7th April, she was suddenly seized with profuse uterine hæmorrhage, in consequence of which she fainted and remained for a long time insensible. She was placed on a bed, cold water dashed in her face, wetted towels laid on the abdomen, and an ether draught administered, by which means she was recovered from her dangerous syncope. The case is detailed for the purpose of mentioning M. Recamier's practice, and relating his clinique on the occasion. The patient should be immediately placed in the recumbent posture, and cold water dashed, not pleno rivo but in drops, upon her face, whilst frictions may be made in the region of the heart. If the syncope depend on uterine hæmorrhage, cloths wetted with cold water should be applied to the abdomen, and bladders filled with pounded ice to the vulva and hypogastrium. M. Recamier does not approve of plugging the vagina, as it only prevents the blood escaping, nor of injections as they tend to detach the coagula and renew the hæmorrhage if it is already ceasing. M. Recamier prefers acting on the capillaries of the bleeding organ by applying refrigerants to those parts or organs with which it is sympathetically * Journ. Hebd. No. 83. A man was seized with apoplexy, and in falling to the ground dislocated the upper extremity of the humerus. He was brought into the Hôtel Dieu and died shortly afterwards, when the extremity was carefully dissected, and exhibited to the pupils by M. Dupuytren at his Clinique, on the 12th of February last. The capsule was torn at its inferior part very near its insertion into the neck of the humerus. The head passed freely out, and could be readily returned within it; the greater tuberosity was fractured and detached from the rest of the bone. In lecturing on this piece of surgical anatomy, M. Dupuytren particularly alluded to the facility with which the head of the bone could be made to pass and repass the rent in the capsule. Dessault and many surgeons of the present day have entertained the opinion, that the small size of the laceration in the capsule presents the greatest obstacle to the reduction of the dislocation; and Dessault carried this notion so far, that he insisted on and practised extended motions of the extremity to enlarge the aperture. This idea appears to M. Dupuytren to be much less generally correct than its advocates suppose; but he does not deny the occasional occurrence of difficulties from this cause. We are not informed whether M. Dupuytren's opinion is grounded on this, or more extensive observations; if the former, we need scarcely observe that a solitary fact proves little, though probably this V. CONGENITAL DISLOCATION OF THE In February, 1830, a curious piece of pathology was shewn in the amphithe atre of the Hôtel Dieu. The dissection was made by M. Loir, interne of the hospital and prosector to M. Dupuytren. The upper extremity of either radius, was displaced from its natural situation, and was situated behind the inferior, extremity of the humerus, above which it mounted an inch at the least. Mi Dupuytren met with a similar dislocation of the radius twenty or twenty-five, years ago, but he cannot distinctly remember whether it was congenital or existed on both sides. In the present instance, it would be difficult to determine precisely whether the dislocation of each radius was congenital, or produced by some violent twisting inwards of both fore-arms, or was "the result of a white swelling.” VI. FOREIGN BODY in the TRACHEA— A little girl, eight years of age, accidentally swallowed a bean, which passed into the trachea and there remained. A violent suffocative cough ensued, and some medical men who were summoned in haste exhibited an emetic without avail. The remainder of the day was passed in alternations of quiet and paroxysms of suffocation, and on the following evening, Feb. 12th, she was admitted into the Hôtel Dieu.." She suffered during the night from violent attacks of dyspnea, and had seve-. ral alarming fits of syncope. In the morning of the 13th the cough was still most distressing, and on applying the ear to the trachea the foreign body. could be heard agitated within it. M. Dupuytren determined on tracheotomy.. which he performed in the following manner. The child being placed on a bed and held by assistants, with the head thrown backwards, an incision nearly an inch and a quarter in length. was made along the median line, a little This and the following articles from above the superior border of the ster the Journ. Hebd. No. 80. num. The skin and subjacent cellular tissue were divided, and the muscles separated from each other, when the trachea was exposed to view. M. Dupuytren, in the next place, with a straight-pointed bistoury guided on the nail of the left fore-finger, divided from above downwards several of the cartilaginous rings of the trachea, with the ligamentous structure uniting them. No air escaped at first, but the edges of the wound being held apart, and the head slightly bent, it issued with much force, and after some violent efforts at inspiration, the bean was driven out from the wound, and fell on the breast of the little patient. The respiration then became natural, the cough ceased, and the child appeared to be well. The edges of the wound were carefully cleansed from the blood, some simple dressing placed in front of the neck, with one or two gentle compresses, and a moderately tight_bandage over all. The bean was five lines in length, three in breadth, and as many in thick ness. In the evening there was much fever, and venesection was required. Next day the respiration was entirely carried on by the tracheal opening, and some pain was experienced in the larynx. Leeches and diluents were employed with great advantage, and on the 15th the breathing was free and unembarrassed,and only a little whistling through the wound was heard. On the 20th, the edges of the wound were brought together, and some days afterwards, its extent being reduced to one-third its former size, the child was taken home by her parents. In a month after the operation they brought her back, and there still remained a minute aperture through which issued a stream of air. wards. One caution is requisite in the VI. FOREIGN BODY IN THE LARYNX- A female between 45 and 50 years of age, presented herself at the Hôtel Dieu on the 20th March, 1830, with violent pain at the top of the larynx on swallowing, or even in the act of respiration. She stated that six or seven days previously she had swallowed a fish bone, since which she had experienced A clinical lecture on the above case the distressing sensation in question, was delivered by M. Dupuytren. In or- and that latterly it had been more severe der to make the first incision through the than at first. The mouth being widely skin and subcutaneous cellular tissue, opened, M. Dupuytren introduced his the head should be directed backwards, finger as far as the epiglottis, which but when the incisions are completed, he thus examined; near its base and this position of the head is very un- posteriorly he could feel a substance favourable for the free escape of air or projecting like a pin's head, but the of the foreign body. In the foregoing rest of it was concealed beneath the case the air was prevented from escap-epiglottis and could not be examined. ing so long as the head was kept back M. Dupuytren, maintaining his forewards, and the bean was expelled from finger on the foreign body, introduced the larynx when the neck was bent for- by its guidance a pair of ring-forceps, No. XXVI. FASCIC. I. Нн |