that she was obliged to walk on the exterior edge of the foot. M. Desgranges, of Lyons, undertook to remedy this defect, and by means of mechanical extension of the member, and well applied pressure on the protuberant angle of the fracture, the most perfect rectitude of the leg was obtained.-Transactions of the Medical Society of Lyons.

49. RETROVERSIO UTERI.

An interesting case of this kind is related in the Ed. Journal of Medical Science, No. 4, by Mr. Wise, the author of an able paper on the trephine, in a former number of this Journal. The woman was 35 years of age, well formed, and of healthy constitution, at the full period of her fourth pregnancy. When Mr. Wise attempted to introduce his finger, he found the canal completely blocked up. With some difficulty he got his finger upwards and forwards to the top of the pubic arch, and there felt the os uteri dilated, and a foot presenting. On examination per rectum, the head of the child was distinguished low down in the rectum, filling the hollow of the sacrum. A consultation was requested, and, in the mean time Mr. Wise learnt that, between the third and fourth month, the flow of urine became obstructed, for which the woman took a variety of nostrums, without relief. In this state, a surgeon residing nine miles distant was employed, and drew off her water once a week, there being a constant stillicidium and great distress. By pressing on the head of the child through the rectum, and laying hold of the feet and dragging it in that direction, the delivery was effected, though with considerable difficulty. After this, the patient expressed herself as greatly relieved; but fever came on, and she sunk on the 15th day.

It is difficult, we imagine, to say whether the obstruction of the urine, at the time above-mentioned, was the cause or the effect of the retroversion. A full bladder may cause retroversion-and retroversion may cause such pressure on the neck of the bladder by the tilting forward of the os uteri, as to obstruct the passage of the water.

For numerous interesting remarks on this subject, by Dr. Campbell, of Edinburgh, through whom the communication was made, we must refer to the original paper in our contemporary.

50. PHAGEDENA GANGRENOSA.

A wretched female from Swan-alley, near East Smithfield, was received into Bartholomew's, with sloughing phagedena of the right labium, which had commenced, five weeks previously, as a pimple, which vesicated, and gradually enlarged to its present size, three inches by one. The surface was irregular, and covered with a fetid, pulpy, thick slough, with dark brown discharge, and a halo of surrounding inflammation. The edges were abrupt, and the surface of the sore was dotted with angry-looking points, considered by Blackadder as characteristic of the disease. The peculiarly fetid odour which usually accompanies this sore was here very annoying; but it was not attended with that darting, though intermitting pain, considered by Mr. Welbank as inseparable from the disease. The right labium was destroyed. The general health did not seem much affected-pulse natural-tongue clean -no look of distress. Mr. Lawrence, therefore, considered all constitutional treatment as unnecessary, and only directed the application of concentrated nitric acid, the sore to be afterwards covered with dry lint. She did not complain much of this application. An opiate. In the course of two ap

plications, some parts of the ulcer began to wear a more healthy appearance, but, generally speaking, the disease was advancing. Three days more trial was given to the acid, but without much effect. It was, therefore, given up, and opium, internally and externally, was resorted to. This plan was not effectual, and the acid was again used, in conjunction with the opium, when success finally crowned the surgeon's efforts.

This case is well reported in the LANCET.

But we have a remark to make on it. We question the principle on which Mr. Lawrence determined not to have recourse to constitutional treatment, because there were no indications of constitutional indisposition. Now, every man of observation must have seen numerous instances where there was no other obvious disorder of the system than what might be suspected from the bad character of a local sore. Such was the case, we think, here, and, in fact, Mr. L. was obliged to lull constitutional irritation before he could master the sloughing ulcer. The pulse, the tongue, and the countenance may not indicate disorder of the system, and yet many of the secretions and excretions may be unhealthy. The surgeon, therefore, should not be too confident in his caustic, or even his scalpel, but wisely combine general with topical remedies.

51. ON MERCURY.'

The writer, from experience of nearly twenty years, offers a few observations at variance with those of a work on Indian Diseases. That author, professing to take for his guide the appearance of the evacuations in dysentery, (a useful guide certainly) asserts, that to continue the use of mercury for months, "or even till ptyalism be produced, is most injurious to the constitution." He also thinks mercury “more beneficial in chronic than acute dysentery;" and that "he is contending against the bulk of opinion in India."

The author is contending against the positive result of practical experience; for the records of practice will prove, that the cessation of fever, in cases where mercury has been used for its removal, has taken place at the moment at which the register states the salutary effect to be visible on the gumsthus, "gums sore, the patient had not his usual attack of fever.” In acute dysentery, the records will shew, that with the ptyalism, that is, immediately on its being established, "improved secretions" forms an article in the entry, and in acute hepatitis, after the most active depletion, and other auxiliaries No one would pronounce his patient safe, till he had evidence of the salutary effect of the mercury on the gums. How, then, is it pernicious or injurious to secure ptyalism? That perseverance "for months," even under the salutary effect, is injurious, and disgraceful to the practitioner who enforces it, is undoubtedly true; but there is an effect of mercury which the writer has seen mistaken for the salutary effect, and the consequence of which has been death. In some from ignorance, in others from inattention, the production of a sore mouth, and continuing the soreness, is all that is sought. It is well known that, when mercury does not produce its salutary effect, it does produce ulceration and a clammy, viscid state of secretion, totally unlike true ptyalism; with this there is great general irritability; yet the writer has seen a patient die from perseverance under such circumstances; undoubtedly from irritation, as, on examination, there was no sufficient cause of death, except the treatment. Even where, from abscess having al

On the Effects of Mercury in Diseases of Warm Climates. By MEDICUS.

ready formed, the constitution will not take on the salutary influence of mercury, the earliest opportunity should be taken to discontinue it; as well as in the case of natural insusceptibility of the salutary effect.

Of the positive, and, it may be called, periodical good effect of the action. of mercury in acute dysentery, the writer has already asserted his conviction, and thinks there can not be found, in medical reports, any such evidence of its effects in chronic disease.

The object of these observations is, to urge the junior practitioner to secure that state of gums, which is almost* invariably the index of the establishment of that mercurial action on which success depends; (in this the previous active depletion will greatly assist) and to guard him very seriously against perseverance in the use of mercury, where the symptoms shew the constitution to be adverse to its favourable or salutary effect. In such cases, the writer believes, immediate change of climate, with the use of nitrous acid, the most advisable mode of treatment.

A combination of antimony with mercury will succeed sometimes when mercury alone will not. Nov. 1826.

MEDICUS.

52. CHRONIC GASTRITIS.

On this important subject we have brought forward much interesting information lately, from continental practitioners. The subject of the present short notice, is a case related by Mr. Brown, in the second volume of the Edinburgh Transactions.

A female aged 40, came under Mr. Brown's care in August 1825. She had been exposed to cold about a month previously, while in a state of perspiration, and had been ailing from that period. She had been affected with diarrhoea, for which she had, as is the usual routine, taken purgative medicines. Mr. B. prescribed something which is not stated, but which was attended with benefit. On the 7th September the following symptoms were noted :-pain in the stomach, immediately after taking food, without vomiting, "or at least without constant vomiting;" and pain on pressing the epigastrium. These symptoms continued unabated till the patient's death, which took place on the 23d-November of the same year. The leading and unvarying feature was pain, sometimes of a burning kind, on receiving food or drink. Vomiting was sometimes solicited by the patient to relieve the stomach. The bowels were generally costive, with occasional diarrheapulse seldom above 90-perspirations troublesome, but no other symptom of hectic fever. The appetite was good to the last, but she ate very little. "She said she was sure she would be quite well if she could do without food." The emaciation was extreme. A few days before her death, a small circumscribed swelling was observed, lying over the region of the pancreas, having the regular pulsation of the aorta. She had been twice or thrice leeched and blistered, and had the antimonial ointment applied, without any marked good effect. She twice took the blue pill to the extent of slightly affecting the mouth, and said she was easier both times. Bitters and chalybeates, as might be expected, produced no beneficial influence. “Opium gave relief in all stages of the complaint.”

Dissection. The mucous membrane of the stomach was every where thickened and vascular. There was no disease in the liver, intestines, spleen, pancreas, or any other organ.

* The writer has seen two instances of small abscess forming in the liver, where the patients were under the satisfactory effect of mercury.

The author very candidly acknowledges that the treatment, in this case, was too inert, especially in the beginning. There can be no question that this was a case of simple dyspepsia, or morbid irritability of the mucous membrane, at the commencement, passing ultimately into chronic inflammation. Had this patient been placed but on the mildest farinaceous food, reduced to the quantity that could be taken without pain or other uneasy sensation, and every thing stronger than water prohibited, she would have got well, without any medicine whatever. Even when chronic inflammation was established, as it was most unequivocally, the same plan of diet would have been the main item of cure. Leeches and counter-irritation should then be weekly employed, and mild anodynes, especially hyoscyamus with minute doses of blue-pill, to keep the secretions in order, should be given at intervals of not more than six or eight hours.

Many are the cases in which irritation passes into inflammation, from the want of attention to diet, and from the injudicious use of tonics and stimulants! But the practitioner, it must be owned, has not often such influence over the patient as to enforce the proper system of diet. The case related conveys a very instructive lesson, and it would be well if patients could be made sensible of the danger they run in the indulgence of their appetites.

83. COMPOUND DISLOCATION OF THE ANCLE-JOINT.

A very bad case of this kind lately occurred in the hospital practice of Mr. Tyrrel, and was treated successfully. A man of middle age had his foot caught under the gate of the swing-bridge in the London Docks, by which the ancle-joint was dislocated, and the integuments lacerated so as to expose the joint. The tibia protruded two inches or more, and was fractured across, the extremity being separated from the rest of the bone. The other structures about the articulation were much injured. The fibula was also fractured at some distance from its lower extremity.

Mr. T. removed the separated portion of tibia, and reduced the dislocation, bringing the soft parts together, as well as he could, and retaining them in co-aptation by proper dressings. The limb was then laid, with the knee bent, in a hollow splint, another short splint being placed along the inside of the leg. Evaporating lotions were applied. The febrile excitement was not great; and, although some sloughing took place, suppuration was established, granulation ensued, and the man did well.-LANCET.

54. SLICINg structure in quest of funCTION,

We are not among those who decry experiments on living animals; but we think the attempts which have lately been made, and so often repeated, of slicing and cutting the brains of animals with the hope of detecting the functions of its different parts, are hardly justifiable by the prospect of any advantage that may thence result. Dr. Hertwig, of Berlin, has carried on these experiments, of late, very freely; and the only thing curious that we can see in them is, that, if experiments on hens, pigeons, and rabbits, can determine the localities of the mental faculties, or the seat of the soul in the brain, the phrenologists are all in the wrong. He concludes, that the hemispheres of the cerebrum are the "true seat or the central point of all the perceptions, of consciousness, of understanding, and the will”—that these powers of the mind and of the senses have a common seat in the hemispheres-and yet that "the consensus communis is not dependent on the hemispheres alone, since it remains after they have been destroyed." If this be not converting the obscurum into obscurius, we know not what is!

Dr. Hertwig will be a stumbling-block to the materialists-for if the faculties remain after the brain is destroyed, we need no farther argument for the immateriality of the soul!

55. MR. ABERNETHY ON SPINAL DISEASES.

Mr. A's lecture on this subject, as reported in one of the late numbers of the Lancet, contains some opinions and practices which deserve a few

comments.

Mr. A. dislikes the "genteel" term concussion, as applied to the spine, because it merely conceals our ignorance; and he, therefore, gives it the more scientific appellation of "jarring," which, in our humble opinion, adds nothing at all to the elucidation of the accident. Mr. A. believes that dislocation, without fracture, can only take place in the cervical portion of the spine. He says we cannot reduce these fractures, for if we pull at the spinal column, for the purpose of extension, we may "jerk the medulla spinalis asunder." He, therefore, advises his pupils to keep the parts still. Most of these cases are dangerous; but our lecturer gives us the pleasing consolation that he has seen "" Imany cases of recovery, even where the fractures were in the neck." Mr. A. has certainly been much more fortunate, in this respect, than his neighbours. He relates the case of a medical student, who fell into a gravel-pit, and fractured the spine, about the middle of the dorsal portion. In two months, he was so well as to be able to sit up and play cards, &c. but all below the fracture was completely dead. Mr. A. does not condemn the operation of trephining the spine, as practised by Mr. Tyrrel, but thinks it should not be attempted till all symptoms of inflammation have subsided-the same as in cranial fractures, with depression and compression. Now, if we wait till the symptoms of inflammation have subsided, it will be too late to save the spinal marrow from compression; and, therefore, if the operation is to be attempted at all, let it be done before the inflammation begins. It appears that Mr. A. did actually propose such an operation himself.

On distortions of the spine, Mr. Abernethy is, as usual, very droll. He says these "are not diseases but deformities;" yet in the same column he informs us that "he does not see these curvatures happening, except where there is some constitutional disorder." If this be the case, there surely must be some connexion between the constitutional disorder, and the spinal curvature. Particular postures, then, cannot be the sole cause of these deformities, since such postures are assumed occasionally by all young people. The fact appears to be, that the spinal column and its muscles partake of the constitutional disorder, and give way under postures or habits which, in perfect health, would produce no distortion. The whole therapeutics of the Lecturer may be comprised in a single line—alternate rest in the horizontal posture, and active exercise. Where there is anterior or posterior curvature, dependent on diseased vertebræ, rest without exercise must, of course, be enjoined. In these precepts the novelty is not of the very first order; yet they are made to cover a vast quantity of paper in the pages of the Lancet.

56. TREPHINE, IN INJURIES of THE HEAD.

We have observed a paper in the New York Medical and Physical Journal for March 1820, which, as it bears upon the subject we discussed in Art. 5, of the Periscope of this number, we shall notice here. It is a case of epilepsy, after fracture with depression, cured by trephining.