the former, descended, and swept round to meet the other incision, in a manner which cannot well be described in words. M. Lisfranc then dissected away the diseased parts, with great care not to wound the spermatic cord or the testicle. Considerable hæmorrhage occurred during the operation, which was exceedingly difficult. In order to remove the cancerous disease of the penis and integuments over the pubes, incisions and dissections were carefully and adroitly made by M. Lisfranc. On the penis itself, a longitudinal incision was made through the diseased parts, to ascertain how far the roots of the cancer spread. They were found, in some places, to penetrate the fibrous envelop of the corpus cavernosum, and these points were removed either by excision or scraping with the edge of the scalpel. The operation was necessarily tedious and excessively difficult; but was, at length, brought to a conclusion, and dressings applied. Strong fever rose after this terrible operation; and next day it was thought proper to remove the dressings. The wound was considered to be in a good condition; "mais cette enorme denudation était affreuse à la vue." The patient was bled, and kept very low. On the 7th the fever was abated; but pain was great, and the wound was red and tumid. Forty leeches were applied to the abdomen and around the wound. Emollient poultices were applied. The penis was greatly swelled; but the swelling was œdematous. By the 11th suppuration was established, and the wound beginning to clean. Some nourishment was allowed. On the 14th the dressings were wetted with the solution of chloruret of soda. By the middle of September the whole surface was healed, and M. Lisfranc presented the patient to the Royal Academy of Medicine, the members of which verified the completion of the cure.

We think M. Lisfranc deserves a civic crown for thus preserving the life of a fellow-creature, who, but for this most arduous operation, was doomed to a lingering and torturous death.

12. RHEUMATIC OPHTHALMIA.

[Glasgow Eye Infirmary.]

In a former number of our contemporary, Mr. Mackenzie offered some observations on catarrhal ophthalmia, (No. 11, Med. Chir. Rev. p. 173,) and now takes up the subject of rheumatic inflammation of the eye.

1. In respect to this last, it is seated in the albuginea, sclerotica, and periosteum, within and round the orbit.

2. Redness. This is zonular, and seated under the conjunctiva, whereas, in the catarrhal ophthalmia, the redness is reticular, and the turgid vessels are evidently conjunctival.

3. In the catarrhal ophthalinia the mucous membrane is inflamed, and there is an increased secretion of mucus. The rheumatic species attacks the fibrous membranes of the eye, and is unattended by any morbid secretion.

4. The pain of the catarrhal ophthalmia is compared to the feeling

* Professor Mackenzie. Med. and Phys. Journ. Jan. 1827.

of sand or roughness between the eye-lids-does not extend to the head-and is felt more in the morning, or when the eyes are moved : -the pain of the rheumatic species is pulsative and deep-seated-the chief pain not being in the eye, but round the orbit, in the eye-brow, temple, cheek, and side of the nose. It is severely aggravated between, sunset and morning.

Compared with the catarrhal, this species is rare-perhaps one to ten. Its exciting causes may generally be traced to currents of cold air during perspiration, or to cold, in some way applied. It is more seen in middle, than in early or late periods of life. In general, there is no tendency to chemosis in the pure rheumatic ophthalmia, nor do the eye-lids take part in the disease. It is uniformly attended with dimness of vision, slight contraction of the pupil, and sluggishness of the iris. One eye only is, in general, affected, especially at first. The iris becomes slightly discoloured, and the attending iritis may go on to effusion of coagulable lymph within the pupil. The iritis in these cases, however, is not generally very severe. Mr. M. has not seen the disease terminate in any form of suppuration or of ulceration. The access of light is not very distressing. The eye is at first dry and hot; but after blood-letting and proper means have been used, there is a considerable epiphora. The pain is of a stinging kind, extending to the whole of the orbit, and greatly increased by heat. Occasionally it is confined exactly to one half of the head. It never ceases entirely while the disease continues; but it varies much in degree, coming on with severity about six o'clock in the evening, and being at its acmé about midnight. Symptomatic fever accompanies the pain, rising pari passu with it. The digestive organs are deranged, the bowels confined, and the excretions morbid.

Treatment. Differing from Mr. Wardrop, our author insists upon general and local bleeding. Mr. W. has found little benefit from leeching-Mr. Mackenzie has found great advantage in this measure. Surgeons will differ. Perhaps their patients are of different constitutions. The banks of the Thames and the banks of the Clyde present different aspects. Those who reside on them are not less different in constitution. Mr. M. bleeds from the arm the first day, and the next applies leeches to the temple. If the vascular action continues strong, and the symptoms unrelieved, he repeats the venesection.

Calomel and Opium. This combination has never failed to prove highly useful, "in checking the circum orbital pain, restoring the digestive system to its healthy state, exciting the skin, and dissipating the redness of the eye." Two grains of calomel with one of opium are to be given every night till the gums are affected, when the calomel may be omitted, and ten grains of Dover's powder substituted.

Opiate frictions are serviceable-a large blister to the nape of the neck is of much benefit. Topical applications to the eye are of no use; but when the febrile and painful symptoms have abated, the vinum opu may be used. The pupil of the eye ought to be kept under the influence of belladonna all the time. Gentle aperients-diluents-and in

the chronic stage, tonics, especially the arsenical solution, will be

necessary.

Three well-marked cases are given in illustration, from the journals of the Glasgow Eye Infirmary. These we need not touch. We shall be happy to see Mr. Mackenzie's paper on the third species, or catarrhorheumatic ophthalmia.

13. CHIRURGICAL CLINIQUE OF SAINT-LOUIS.

[M.M. Richerand and Cloquet.]

This report is drawn up by Mons. Hutin, (interne des hôpitaux) and commences with a very interesting case of intestinal suture, or entero-raphia, the particulars of which we shall now state.

1. Operation for Hernia-Wounded Intestine.-Nicholas le Jume, 41 years of age, entered the St. Louis Hospital, on the 13th of July, 1826, presenting the following symptoms to the house-surgeon :-inguinal hernia, on the left side, very large-pain in the abdomen-colick -constipation since the rupture became strangulated (early in the same day)-frequent vomiting-breathing laborious-pulse small, quick, and irregular-features shrunk. The taxis had been ineffectually employed before he came to the hospital, and afterwards by the house. surgeon. M. Cloquet having also tried to reduce the hernia, without success, proceeded to the operation. After laying bare and dividing the hernial sac, several convolutions of intestine presented themselves, greatly distended with gas, the intestinal coats being red and thickened. He proceeded to enlarge the opening of the ring, by the bistoury, carried on the point of the forefinger, upwards and outwards. In withdrawing the knife, an assistant let go a knuckle of intestine, which suddenly glanced on the edge of the instrument, and the consequence was, a transverse incision in the gut, full an inch in extent. Gas and fæcal matters rushed out in abundance. The operator instantly determined to take this opportunity of putting into execution the plan of M. Jobert, who had made a great number of experiments on animals, with the view of trying the results of ligatures applied to intestinal wounds. The protruded intestine was first emptied of its gazeous and other contents, and then three interrupted sutures were made, at convenient distances, across the wound. The plan adopted by M. Jobert, (who assisted at the present operation) is to plunge the point of the needle in at a little distance from the wound, and then bring it out again near the edge of the cut-the same is done (inverting the order) at the opposite aide of the wound, and thus, when the knot is tied, the peritoneal surfaces come in contact, and a kind of seam is left on the internal surface of the gut, in the line of the wound. Adhesive inflammation soon glues the sides of the wound together, when thus stitched with the peritoneal surfaces in contact. The ligatures being thus applied, the ends were cut close off, and the bernia was returned into the abdomen. In a few hours the patient's bowels acted, the pulse rose, the countenance improved. In the evening he complained of pain in the left iliac region, and of tenderness

in the abdomen generally. Twenty-five leeches were applied to the region above-mentioned, together with emollient fomentations, enemata, &c. The pain went off, and he passed good night. 14th. Some return of abdominal pain this morning. Leeches were again applied, and the bowels were freely opened. A few days afterwards the bowels became confined, but without any bad symptom, and a dose of castor oil brought away abundant evacuations, From this time, the cure went on prosperously, and the patient recovered without a single accident. Since his discharge from the hospital, he has been seen several times, and continues in good health.

2. Nitrate of Quicksilver. This metallic preparation is coming into considerable notoriety in France, and especially in the St. Louis Hospital, as a caustic in scrofulous, syphilitic, and even cancerous ulcerations of the face-and in various cutaneous eruptions, which, says the reporter," have yielded, as if by enchantment, to the action of this new remedy." Some cases are detailed of the efficacy of the nitrate, but we need not insert them here. The nitrate of mercury is a powerful escharotic, and the nitrico-oxyde of mercury has long been employed in this country as a remedial agent of great efficacy, in the form of the unguentum hydrarg. nitrico-oxyde.

3. Acetate of Lead, as a Sedative in Cancer. A number of females, affected with incurable and most painful cancers of the rectum or uterus, have had their sufferings greatly mitigated by warm baths, in each of which was dissolved an ounce of acetate of lead.

4. Cranial Fractures. We have hitherto been accustomed to regard the Continental practice, in regard to sanguineous depletion especially, as very inert. The French are now growing very hold on this point, and probably may soon rival their British neighbours.

In respect to fractures of the cranium, accidents which are very frequent in the St. Louis Hospital, the reporter observes that, the danger, does not arise from the mere injury to the bone, but from the injury which the brain sustains then or afterwards. The following is the treatment pursued in the above institution. When the patient is received, he is bled largely-not to 20 or 24 ounces-but to the extent of 80 or 100 ounces" vingt à vingt cinque palettes"-after which, derivatives and diluent drinks are prescribed.

Case, in illustration. Piron, a young man of strong constitution, a stone-mason, fell from a scaffold on his head, and was immediately conducted to the hospital, when the surgeon on duty, M. Paillard, found him presenting the following symptoms:-a large wound, with contused edges, on the posterior and lateral part of the left side of the head, denuding the lambdoidal suture, and part of the occipital bone, which was fractured in several directions, and the loose fragments, many of them, depressed. The breathing was slow and deep-pulse small and irregular-face pale-all parts of the body strongly convulsed-penis in a

state of erection, and the intellect deranged. The patient was bled to twenty palettes (eighty ounces)-sinapisms were applied to the feet. The convulsions ceased-the erection of the penis disappeared. Next day the breathing was free--pulse calm-intellectual functions restored. On the fifth day, the patient was so well that he wished to leave the hospital, notwithstanding the fracture of the cranium. It was with difficulty he could be restrained from leaving the institution before the wound was well, which it was in a very short space of time.-Biblio thêque Medicale, Novembre.

The above was bold practice, considering the state of the pulse, and condition of the surface; but the end justified the means. It is intended to state a series of cases, exemplifying this decisive system of depletion.

14. CONSTITUTIONAL PREDISPOSITION TO SCIRRHUS,

[St. George's.]

Under this head, Mr. Jeffreys has published some cases, in the February Number of the Medical and Physical Journal. The predisposition in question is a melancholy pathological fact, which tends to check the sanguine hopes of the operator, when removing external tumours of the scirrhous character. We shall glance at some of these cases.

Case 1. A woman (aged 45) was admitted into St. George's for a tumour in the right breast. Seven years previously she was operated on by Sir Astley Cooper, at Guy's, for a scirrhous tumour in the same breast. The present tumour commenced soon after the operation abovementioned, and was now the size of an egg, hard, irregular, scirrhuslike, free and moveable, with only an attachment to the integuments above. The general health appeared good, and the uterine functions had ceased. Some of the absorbent glands in the axilla were slightly enlarged, but not at all indurated. At her own particular request, the tumour was removed, and the glands in the axilla subsided to nearly their natural size. She was discharged cured in less than two months. One year afterwards the patient returned," in the last stage of jaundice," being much emaciated, and complaining of occasional acute pain in the epigastric and hypogastric regions. The liver could be felt enlarged. She died in a month from this period.

Dissection. Several small, white, hard tubercles were found under the integuments of the thorax, and a few in the pleura costalis. The lungs were sound. Some serum was effused in the abdomen. The liver was enlarged, indurated, and full of large white tubercles. Some of the mesenteric glands were enlarged and hardened, and a few tubercles were observed under the peritoneal covering of the intestines and bladder.

It is a pity that Mr. Jeffreys did not state what was the condition of the gall-bladder and ducts; and whether the jaundice was occasioned by mechanical obstruction to the course of the bile, or by the organic disease of the liver, as this is a litigated point of pathology at the present

moment.