was seized with the pain in the forehead and other symptoms, without any previous rigor. Says he has felt occasional chills and nausea since the occurrence of the accident, and they have not latterly been worse.

V. S. brach. ad žxij. Hyd. Sub., Pulv. Ant. ää. gr. iij. in pil. ij. stat. H. Senn. Lot. spt.

5th. Pain in head rather relieved pupils dilated and sluggish, more especially the left-pulse frequent and full-motions dark and offensive.

Hirud. x. fronti. Glacies capiti raso. Enema Olei ricini.

On the 6th, he was still better, and the pain in the forehead was much diminished. He complained of much tenderness at the back of the right ear, and was perfectly deaf on that side. The pupils were less dilated, but had altered in toto, for the right was now more affected than the left. The pulse had sunk from 112 to 62. He was ordered calomel and jalap, and the ice was discontinued in the evening. On the 7th the left pupil was again the most dilated; he had little pain in the forehead. The purgation was continued, with cold to the head.

On the 8th, a blister was placed on the back of the neck. The medical man who had attended him, stated that the lad had been suffering from pain in the head and oddness of manner for some time previous to the fall-that one of his brothers had died of disease of the brain-and that the accident was of so little consequence, that no mention was made of it to the parents for two days after its occurrence.

On the 10th he was much better, had no pain in the head, and the pupils were more natural. After considerable pain in the right ear, a certain quantity of matter was suddenly discharged from it with relief. He continued to improve, and on the 15th, he could walk much better, although he still reeled and had an unconquerable disposition to cross his legs. Another blister was placed behind the ear, the purgation was continued, and on the 19th, the blister was again repeated, and the surface dressed with mercurial ointment.

On the 26th he complained of headache, and was again blistered. On the No. XXVI. FASCIC. III.

6th July he could walk by himself with tolerable steadiness; porrigo scutulata had appeared upon the head. This was attacked with the strong acetic acid, and an ointment consisting of unguent. lytt. 3ij., æruginis æris, Di., cerat, cetacei, 3j. This had no effect on the porrigo, which became established fully, but on the 21st of July, he was so far recovered as to be discharged cured.

He had no pain whatever in the head, nor vertigo; could walk and even run, with only a feeling of stiffness; but had lost the hearing of the right ear.

We find we have not room for some interesting cases of scalp wound, which we hoped to have related; they will form the subject of a future report. The first case detailed in the present one, is a tolerably good sample of the symptoms and progress of concussion. Two bleedings and a blister were sufficient to remove the symptoms and effect a perfect and permanent cure. In this hospital we have rarely or never witnessed those frightful cases of concussion, which the works of some au→ thors would lead us to consider as common. To trust to their descriptions, one would imagine that patients were frequently dying in the first stage, and that the second was one of unmeasured and unmitigated violence, only to be put out, if extinguishable at all, by the abstraction of "immense quantities of blood." From the character of the writers who have made these statements, it is impossible to imagine that they have attempted to describe more than they have actually witnessed. Perhaps these differences of symptoms may admit of explanation in differences of treatment. Mr. Cooper, and, if we recollect aright, Mr. Abernethy, recommend the exhibition of stimuli in the first stage of concussion, and by a natural consequence increase the excitement of the second. The cases of concussion in which stimulants are required are extremely rare, and their

administration, when not absolutely necessary, must be injudicious and injurious. Indeed, if one may judge by cases, the profession appear to be of this way of thinking, for again and again we have seen patients admitted in a state of complete collapse who had been already bled from the arm. They were blooded because they were run We do not mean to say that this is advisable treatment, but the practice of this hospital is amply sufficient to prove, that in the great majority of cases the patient will recover from the state of depression, without the employment of measures calculated to increase the subsequent reaction.

over.

It is in fact very rare for individuals to die of the first stage of concussion, unless it be complicated with other extensive mischief, as fracture of the skull and laceration of the brain, extravasation, internal hæmorrhage, or so forth. In such cases stimulation will do no good, it may do harm; but, if the patient is in danger of sinking, we must necessarily have recourse to it.

The perusal of the foregoing cases will suggest many reflections to the professional reader, on the symptoms, treatment, and remoter consequences of concussion of the brain. It is certainly a subject of considerable practical interest.

LIL.

NEW MODE OF TREATING RUPTURES OF THE URETHRA.

M. DESRUELLES, surgeon to the Val de Grace, has published in the Journal des Progrés, No. XVIII, a kind of memoir on lacerations of the urethra. Several cases of rupture of this canal and considerable hæmorrhage in consequence, are related. In one, there being inflammation of the urethra and retention of urine, the employment of the catheter gave rise to such formidable hæmorrhage that the patient was lost. In another the individual was nearly destroyed by bleeding, in consequence of the introduction of the caustic bougie. In a third case acute inflammation of the urethra was followed by rupture, infiltration of urine into the surrounding parts, and death. M. Desruelles remarks that horse exercise is one of the most frequent causes of this accident in persons labouring under chronic inflammation of the urethra, for he has almost always observed it in horsemen. As laceration of the urethra is generally combined with, or dependent on contraction of the canal, M. Desruelles conceives that it is a matter of importance to dilate the strictured part, without interfering with the remainder of the urethra. He has there

1

fore employed a hollow silver tube, one or two inches in length, and of different diameters, which is introduced into the contracted part, and withdrawn by means of a silken thread attached to one of its extremities. Before its introduction it is necessary to introduce a bougie, in order to learn the requisite size of the tube, and the depth to which it must be passed. The silken thread is then passed through what may be termed a conductor, the tube being thus attached to its extremity. The tube is then pushed before the conductor into the strictured part of the urethra, where it is left, while the conductor is withdrawn. The silken thread being fastened round the penis, or to proper tapes, prevents the tube from slipping farther into the urethra or becoming impacted there. The tube is left in for twenty-four or thirty-six hours. We cannot say we see any great advantage in this complicated manuvring. It is much more clumsy, and much more difficult than the introduction of a silver catheter, more likely to create irritation, and not a whit more adapted to effect a cure. In the abscess of the perineum, depending on fistulous opening into the urethra and stricture, such a mode of proceeding would in most cases be impracticable, for it is often impossible, always difficult to introduce the more manageable

bougie. Besides, if any accident happened to the silk thread, or if severe inflammation of the urethra and surrounding cellular membrane supervened, it would be but an awkward thing at the best to have a little tube pent up in the inmost recesses of the urethra. However, our readers may form their own opinions on the subject.

LIII.

M. PIORRY'S NEW STETHOSCOPE.

M. PIORRY sets out with the position, that metals will conduct sound sufficiently well to admit of being employed as stethoscopes. Metal will also serve for the pleximeter, or that thin plate attached to the large end of the modern stethoscopes, generally made of ivory, and used for percussion. Having as certained these facts M. Piorry determined to apply them to the construction of an instrument, which should be at the same time light and portable. His new stethoscope consists of a tube of copper two lines in diameter and six inches long; the length admitting of being increased to the employer's taste, by fixing a second tube upon the first. The pleximeter should be eight lines in diameter, and of copper also, well polished, rounded and fitting well at the edges. Two lines from a point of its circumference is an opening which screws on one of the ends of the metallic tube. The opercule is an inch and a half in breadth, and in its centre is a hole which receives the other end of the cylinder. If the impulsion of the heart, pectoriloquy, bronchophony, or ægophony are to be explored, the flat side of the pleximeter is to be applied to the chest; for the respiration, sounds of the heart, and so forth, we must employ the hollow side. M. Piorry imagines that the great portability of this instrument will render mediate auscultation more generally available than it is at present. For our own parts we think the wooden stethoscopes now in use are by no means incommodious. The shaft is extremely slim, and consists of two separable portions,

whilst the ear-piece and ivory pleximeter screw off the stethoscope and fit upon each other.

LIV.

POISONING BY OPIUM AND BELLADONNA, USED AS AN INJECTION.

MADAME æt. 22, had been tormented for some months by a dartrous eruption on the vulva. Having tried various means without relief, she applied a strong solution of opium and belladonna, which gave her some ease. On the 19th of November, 1829, she determined to use the narcotics in the form of enemata, and mixed a pint of the lotion with sufficient water to make three injections, each containing a scruple of opium and half an ounce of the leaves of belladonna. She took the first at eight o'clock in the evening, and the second and third shortly after the first; all three were returned, and some fæces were discharged. At halfpast eight she went to bed, feeling rather confused. Her husband, a medical man, found her sleeping soundly at half-past nine, and did not disturb her. At midnight, however, finding her still buried in the deepest slumber, he became alarmed and sent for Dr. Solon, Her face was now extremely pale, the pupils dilated to the utmost, the tongue dry, deglutition difficult, the respirations short and frequent, the pulse small and 130. The limbs were perfectly motionless and the skin insensible to pinching or irritation of any kind. A purgative injection was immediately exhibited, a free bleeding practised from the arm, ten leeches placed behind each ear, sinapisms applied to the thighs and legs, and ether draughts administered by the mouth. At five o'clock next morning the patient opened her eyes, uttered a few unconnected words, and vomited some bilious matters. In the course of an hour she awoke, as from a painful dream, recollecting nothing of what had occurred. Vision was imperfect, she appeared to see things through a thick veil, and whenever she closed her

eyes her ideas became confused and incoherent. We need not pursue the details, suffice it to say that the lady recovered from all her severe symptoms. The parts, however, to which the sinapisms had been applied, sloughed in consequence of the length of time they had been continued, and many months elapsed before she could walk about. The eruption on the vulva was quite cured by this severe discipline, and the patient subsequently went well through a confinement.

LV.

HEROIC TREATMENT OF HYSTERIA.

DR. LUCAS contributes a case of hysteria which may give us pause, to the Glasgow Medical Journal for August, 1830. His object in communicating the case to our contemporary is rather singular for the candid manner in which it is avowed, for he considers it, he says, the bounden duty of a Scotchman to support, as far as he can, every periodical medical publication emanat ing from the Scotch press. We had thought that the more liberal and distinguished natives of the land of cakes, had begun to disclaim that selfish and too-national feeling which Dr. Lucas openly expresses.

The subject of the case was a stout single woman, 40 years of age, who was seized, in December last, with a violent hysterical attack. It assumed the form of the most excruciating pains referred to the scrobiculus cordis, the patient perspiring profusely, and uttering dreadful cries. Her pulse was full, strong, and rather hard; the attack had come on quite suddenly. The Doctor bled her to 40 ozs. from as large an orifice as he could make, but without relief. He then gave her, in the course of 20 minutes or less, six drachms of laudanum in warm peppermint water, when she began to eructate, and suddenly exclaimed I am quite well.' The laudanum only produced an intoxicating effect, but was followed by some nausea for two or three days. Dr. Lucas purged her, and gave her an emetic which

operated beneficially, but on the third day she was seized with another bys. terical paroxysm like the first. Dr. Lucas's friend, imitating his Pythias, gave the woman three large tea-spoons full of laudanum, and three pills of solid opium, each weighing two grains, in the space of ten minutes. The pa roxysm was removed, but others cons tinued to recur till a large blister dispersed them for some time. In another paroxysm Dr. Lucas gave her four drachms of laudanum in the space of 15 minutes, but the cure was produced by tonics and port wine. Now really we think that the treatment was a vast deal too violent, and had the patient been a London female, instead of a stout Glasgow lassie, we doubt whether Dr. L. would have witnessed more paroxysms than one. The bleeding was altogether unnecessary, and the doses of laudanum were much too large. We cannot but think it ridiculous to crowd drachm after drachm of powerful medicines into the human stomach, before the first doses can have had sufficient time to produce their effect. Thus, in 15 minutes, Dr. Lucas's friend gave three large tea-spoons full of laudanum and three pills of solid opium. Had he possessed a little patience it is pro bable that a drachm or two of laudanum given in an ether or camphor draught, would have answered just as well with out any of the risk attendant on the ul tra treatment. We do not speak on speculation, for we have witnessed quite as violent cases as this of Dr. Lucas's, but never did we see, nor do we ever expect to see, such violent measures required.

LVI.

ANEURISM BY ANASTOMOSIS.-BOTH CAROTIDS TIED.

DR. MUSSEY has published another case of this kind in the American Journal of Medical Sciences for February, 1830. The patient was a man 20 years of age, with a large purple pulsating tumour situated on the vertex of the head, hav ing a sluggish ulcer at its apex, which occasionally bled. The tumour had

existed since infancy, but increased greatly within the last three years. The left temporal artery and vein were much enlarged, and upwards of twenty arte. rial branches, each as large as a goosequill, were seen actively pulsating on the scalp and running to the tumour. Dr. Mussey tied the left common carotid without success; on the 12th day he tied the right, and in four weeks the tumour diminished to a third of its original volume. After this it began again to increase, and astringent applications with pressure were had recourse to. On the 22d of November, six weeks from the second operation, Dr. Mussey removed the tumour altogether. This he did by making an incision round it through the soft parts, and then rapidly dissecting away the whole mass from the pericranium. Not more than an inch and a half of the scalp was divided at a time, and firm compression was made upon each lip of the incision while the vessels were secured by ligatures, more than forty of which were applied in making the circuit of the tumour. Notwithstanding these precautions nearly two quarts of blood were lost during the operation, which lasted more than an hour. The patient was faint, and continued so for some time. In eight weeks the wound was nearly healed, but some months elapsed before the cuticle became sufficiently firm. The patient returned to labour upon a farm in March or April, and has since continued most industrious and athletic. This adds another to the list of failures, from treating aneurism by anastomosis by tying the carotid arteries. We have argued the question again and again, and it now only remains to publish these cases from time to time, if surgeons will persist in performing these operations. We do not approve of excision of such large aneurismal tumours. The hæmorrhage in this case was dangerous, and might have been fatal. The ligature is preferable, and although there are few tumours so large as not to admit of it when ingeniously applied, yet even supposing there were such, a part of them might be tied and strangulated at a time. These are mere hints, for we have not space to enter more fully on

the consideration of this very practical subject.

LVII.

APPLICATION OF THE CUPPING-GLASS TO THE EMPTYING OF ABSCESSES, OR OTHER CAVITIES.

THE cupping-glass may be very usefully applied to the above purposes. Our readers are aware that many methods of evacuating large abscesses have been recommended by eminent surgeons. Mr. Abernethy makes a small puncture, carefully squeezes out the pus, and uses every precaution to close the opening. Mr. Brodie is rather disposed to make a larger puncture, and, without any squeezing or kneading whatever, to allow the matter to drain into a fomentation-cloth, taking care to keep the patient in a state of perfect rest. Where many and opposite mea sures are adopted by men of talent and observation, the result of none is uniformly successful, and we have seen bad consequences ensue after both the methods to which we have alluded. The fact is this: in many cases of psoas or other abscess, the cellular membrane is very extensively destroyed, the muscles perhaps are eaten away, the bones carious, the constitution bad. Now when such is the mischief, bad consequences must follow any plan we can devise, or occur if no operation is attempted; the patient being rather destroyed by the disease than by any operative injury inflicted. But still there are milder cases in which the issue is not necessarily fatal, and in which the judicious eva cuation of the abscess will effect a cure. It is certain that if such abscesses be opened in an improper and unskilful manner, if there be much squeezing and kneading and probing, the parietes of the cyst inflame, its contents become putrid, sulphuretted hydrogen gas is locked up, and a train of the most characteristic typhoid symptoms are the consequence. Now we have seen Mr. Brodie employ the cupping-glass with much advantage in the emptying of such abscesses. The pressure made by the atmosphere is equable and regular,