Case 2. This was an aged female of 70, who came into the Hospital, in May, 1826, with a small scirrhous tumour in the left mammaan indurated mass of glands in the axilla-oedema of the arm-prominence and pain of the abdomen-pain over the sacrum-irritation in making water-furred tongue, and quick pulse. She was, of course, no subject for a surgical operation, and remedial treatment had no other effect than, perhaps, prolonging a wretched existence for six or seven months, when she died.

Dissection. The tubercles in the breast and axilla presented the genuine characters of scirrhus. There was a large tumour in the abdomen exhibiting the same kind of morbid structure, and involving many parts in a mass of adhesive inflammation. Between the rectum and sacrum was another tumour, the size of an orange, embracing the posterior half of the gut, and contracting its calibre. There were also some tubercles in the liver.

This woman only dated her complaints some eight months before she applied for relief at the hospital.

Case 3. A female, aged 44, had had a tumour in the mamma for two years. It presented the character of scirrhus, and some of the axillary glands were enlarged and indurated. She complained of darting pain through the breast, and occasional pain and numbness of the There were two small ulcerations on the mamma. In a week after admission, she was seized with severe erysipelas of the diseased breast, which spread to the side and back, of which she died on the third day.

arin.

Dissection. The mammary tumour was genuine scirrhus, and those in the axilla were white tubercles. Within the thorax, immediately under the diseased breast, there was a scirrhous tumour, as large as half an orange, situated between the ribs and pleura.

Although these and many other cases which might be cited show the general disposition to scirrhous affections in some constitutions; yet, while the ablation of a scirrhous tumour is even occasionally successful, that ultimum remedium must be applied, in the absence of palpable proof that this disposition exists.

15. EXTIRPATION OF THE PAROTID GLAND.

[M. Lisfranc. La Pitié]

We no longer hear it asserted by eminent surgeons, that the parotid gland cannot be entirely extirpated. We have placed on record, in this Journal, several well-attested cases, and are now about to add another to the list. The operation was performed by M. Lisfranc, the distinguished surgeon of LA PITIÉ.

Case. J. Prevost, aged 60 years, was received into hospital, on the 1st of June, 1826, on account of a fibrous tumour, the size of a man's fist, occupying the region of the parotid gland, and extending beyond that in several directions. Although the tumour was moveable in some directions, it was fixed in others, shewing that its roots penetrated deep,

and were adherent to the neighbouring bones. After a few days of proper regimen, the operation was performed, in La Pitié, on the 5th June. We need not detail the steps of the operation with any degree of minuteness-since the same process will rarely be applicable to two cases. After elliptical incisions had been made, so as to embrace the tumour, and some dissection had been gone into around it, during which several vessels were divided, it was attempted to insulate the disease by the fingers and by the handle of the scalpel; but this was found to be quite impracticable, on account of the number and strength of the ligamentous attachments to the surrounding parts. The surgeon was therefore obliged to have recourse to the knife. A tedious, painful, difficult, and dangerous dissection ensued, but was ultimately crowned with complete success, in the removal of the whole of the diseased parts, including the parotid gland. Some of the attachments went to the transverse processes of the first two cervical vertebræ, and to the stylomastoid process. The carotid artery was completely insulated for some space, and no sign of pulsation could be seen or felt, unless the artery was compressed between the fingers, when the rush of blood through the vessel, at each systole of the heart, communicated the sensation to which the term pulse has been applied. One attachment of the tumour was to the condyle of the lower jaw, and others insinuated themselves between the pterygoid muscles. These were all carefully separated; and in this part of the dissection, a large and powerful column of blood sprang to the height of several feet from the bottom of the wound! It was overcome by pressure. The operation was continued amidst appalling hæmorrhage, by which the patient was, for a time, deprived of sense. After he had revived a little, M. Lisfranc kept pressure on the internal maxillary artery, which was divided, while he proceeded to tie, seriatim, the temporal, transverse facial, auricular, and mastoid arteries. The internal maxillary (ou la terminaison de la carotide externe) remained to be secured. With equal difficulty and dexterity, this intrepid surgeon seized and tied this great vessel, amidst deluges of blood; and the operation was finished. The wound was dressed, and the patient put to bed. We need not follow the diurnal reports of the case afterwards. The patient went on remarkably well till the 27th of the same month, the wound gradually filling up. At this time, whether from some dietetic error or other cause, erysipelas of the face took place, attended with vomiting and diarrhoea. Amongst matters thrown up were some preserved cherries. Fever now became developed, and there were evident symptoms of abdominal inflammation. This last was conquered by numerous leeches-the suppuration went on kindly-and the wound was healing fast. On the 2d July a.relapse took place, and some blood appeared in the stools. After various vacillations, during which the erysipelas appeared and disappeared several times, a colliquative diarrhoea came on, and could not be suppressed, He was carried off by this complaint on the 16th July, six weeks after the operation.

On dissection, the mucous membrane was found inflamed throughout its whole extent, and several large ulcerations were discovered, some of which had penetrated through the muscular and peritoneal coats, and

caused extravasation of the intestinal matters into the general cavity of the abdomen. This, of course, was the cause of death. The preparation of the extirpated tumour, including the whole of the parotid gland, was presented to the Academy of Surgery, and there examined by numerous members, who verified the statement of the extirpation. The examination of the part where the operation had been performed, corroborated also the truth of the details already given. It is evident that, as far as the operation was concerned, the surgeon was successful. If he could not control the gastro-enteritic inflammation and ulceration that supervened, there was no blame attached to the surgery of the case. -REVUE MEDICALE, DECEMBER, 1826.

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16. INDURATION OF THE CELLULAR TISSUE.

[South London Dispensary.]

We have, on several occasions, given some accounts of this curious disease, chiefly from foreign authors. Dr. Mac Andrew has recently published an instance of this complaint as it occurred in his dispensary practice. The patient was a boy, 18 months old, who had become feverish about two months previously, and then affected with a diarrhœa and swelling of the lower extremities. These last complaints never left him. The feet, legs, and thighs present a diffused swelling, rendering the skin tense. This swelling has a wax-like appearance, and is nearly colourless, except at one spot, where it has a livid tint. It does not pit, nor is there any pain, on pressure. All the affected parts are cold to the touch. The body is emaciated-the bowels moved nearly twelve times a day. The motions are of yellow, sometimes greenish hue. Some cretaceous powders were given, and a lotion of spirit and mindererus applied to the parts. In two days the swelling had greatly diminished. He died, however, in a couple of days afterwards. There was nothing unusual in the chest. In the mucous membrane of the bowels there were several portions bearing marks of phlogosis. The cellular membrane of the left leg was much thickened, of a light red colour, dense and unyielding on pressure, presenting a granular appearance, not unlike hepatised lung. Below this there is a layer of gellatinous substance, two lines in thickness, containing a fluid. The muscles were unaffected.

The causes of this strange affection are unknown. The French attribute it to cold. It is generally fatal, and the treatment uncertain. Dr. Underwood almost always found the complaint connected with diarrhoea. The improvement of the general health seems to be the main indication. Friction, pressure, and gentle mercurials may assist in removing the cellular induration.—Med. and Phys. Journ. No. 8, N. S.

• 17. DEUTO-IODURE OF MERCURY.

[St. Louis.]

The union of iodine with mercury is now obtaining a trial at the St. Louis Hospital, and other establishments, in various cutaneous affec

tions, and is evidently a most powerful application, which bids fair to be of considerable service in certain diseases of the skin, which resist other means, and so often foil all the efforts of the practitioner. Dr. Paillard has lately read a memoir on this subject, at the Royal Academy of Medicine, of which we shall here give some account.

This medicine is prepared by mixing a solution of hydriodate of potash with a solution of deuto-nitrate of quicksilver, when a copious red precipitate falls to the bottom. The nitric acid unites with the potash, while the iodine combines with the mercury, and forms deutoiodure of quicksilver. It is soluble in a certain proportion of sulphuric, nitric, and acetic ether. One ounce of sulphuric ether will dissolve 14 grains of the deuto-iodure. By evaporation we obtain beautiful red crystals, of a parallelogramic form. The other ethers do not dissolve so large a proportion. This medicine may be used internally and externally; but it is with the external application that we have now to do. It may be employed either dissolved, as above, or mixed with hog's lard, in the way of an ointment. The ointment used by M. Biett, consists of 15 grains of deuto-iodure of mercury--two ounces of lard, and 20 drops of essence of bergamotte.

Our author first used the dento-iodure dissolved in ether, applying it by means of a hair-pencil passed twice or thrice over the parts. The effects were as follows: first, a sensation of cold is perceived, by the evaporation of the ether-next is formed a kind of red crust, by the precipitation of the iodure, causing sometimes a smarting pain, and, in a few instances, small blisters. Ulumately there is a desquamation of the cuticle, with some clefts or indentations. If the brush is passed a good number of times over a part, pain, swelling, and vesication succeed, in the course of a few hours, ultimately followed by a kind of scab, like the crusta lactea of children. These crusts fall off in two or three days, and then the dartrous or other cutaneous affection for which the deuto-iodure was applied, is found to be beneficially modified, and in a state more favourable for the process of cure. Used in this manner, the medicine gives very little pain, and never produces any constitutional disturbance. By such applications our author has seen various cutaneous eruptions removed, and old and rebellious ulcerations healed. But, for many purposes, this form is too mild, especially in cutaneous diseases of long standing, and in engorgements of the glands and cellular membrane of any magnitude. On this account, our author mixed a drachm of the deuto-iodure in an ounce of oil of almonds, expecting by this method to have a preparation possessing considerable caustic powers. At first he applied this liniment with caution, and over a small surface, but afterwards he grew bolder. The layer applied should be in proportion to the degree of cauterisation which is wished. At the first moment of application, the patient feels no pain or heat; but gradually the action of the caustic begins to be perceived. In eight or ten minutes a sense of heat is felt, which increases and changes into burning pain. The neighbouring parts swell, and become hot and painful. In the course of an hour, there is often a discharge of limpid serum from the part. The pain abates in proportion as the application is absorbed

or becomes dry. It generally ceases entirely in the course of four or five hours, leaving only some swelling, which is usually dispersed in the course of one, or, at the most, two days. In a very few cases, the pain of the caustic lasted six or seven hours, and the subsequent swelling two or three days.

In some cases, where the application was made on the face, there came on a sudden salivation, an hour or two after the application was made. M. Manry saw two instances of this kind, in his own practice. The patient may, at any time, mitigate the pain of the caustic, by exposing the part to a current of air, or by fomenting it with any emollient fluid. These fomentations may be made without any danger of washing off the preparation, as this form of the caustic adheres tenaciously to the parts.

This preparation is partly absorbed, and partly desiccated. It combines with the most superficial tissues, producing crusts or scales, which fall off in three or four days, either spontaneously, or by the aid of a fomentation or poultice. The surface beneath generally presents a vermillion aspect, and is strongly disposed to cicatrisation. Our author has seen instances where, in two or three days, the skin being covered with dartrous ulcerations, the cellular substance gorged, thickened, and studded with enlarged glands-the swelling disappeared, the engorgement greatly diminished, and the pain and irritation previously existing ceased.

In scrofulous swellings the caustic effects of this application are little perceptible, during the first or second trial; but absorption appears to commence before any cauterisation obtains. In the course of the third or fourth application to indolent scrofulous swellings, pain and inflammation are produced, along with the other phenomena described above, and then the absorption and diminution of the original engorgement become daily perceptible.

It is to be observed, however, that, in some instances, certain constitutional symptoms were excited, such as fever, malaise, colicky pains in the bowels, and diarrhoea. In no instance did these prove serious; but still they shew that the medicine is a powerful one, and that part of it is absorbed. Our readers will readily see that this application may be used for several purposes, where we now apply common caustic and the potential cautery. We have not space for the cases treated at the St. Louis by our author. They are published in detail, in the Nouvelle Bibliotheque, for December, 1826.

18. AMAUROSIS CURED BY LONG-CONTINUED VOMITING.

[Hospital of Florence.]

This curious case is related by Professor Polidoro, of Florence, and the particulars are as follow:-A female, aged 30 years, of pale lymphatic temperament, had experienced, when only seven years old, a long febrile affection, together with convulsions, and paralysis of some of the members. When these phenomena disappeared, there came on a severe pain in the right orbit and neighbouring parts, with complete blindness