at the edge of the nail has ulcerated, and a bleeding fungus has arisen. He has undergone several operations on the part without success, and each side of the nail being affected here, the operation was more complicated than usual. The root of the nail being cleaned, and the distances marked, Mr. D. with a very small fine knife, resembling Hey's cataract needle, made cautious incisions through the nail, until he had reached the epidermis below, occasionally using a small lever, to show how far he had penetrated. The nail was then gently severed from its attachments, by means of a small pair of forceps, having a rounded point with a sliding clasp. There was no pain nor bleeding, and the relief given was immediate. We certainly think this method of Mr. Durlachre's preferable to the ordinary one of introducing the blade of scissors between the nail and "quick," and so slitting it up. The pain is really excruciating, and besides, it is frequently no easy matter to cut the nail, however you may have pared and thinned it beforehand. With regard to escharotics, we are convinced that, unless the disease be quite in embryo, they will not do alone.Lancet, 209.

12. FRACTURE OF THE SPINE-EXTENSION EMPLOYED.

J. Harlow, æt. 19, was brought into Guy's, July 16th, with injury of the spine, in consequence of a quantity of gravel fall ing in upon him whilst " 'excavating." Examined by Mr. Key, there was found depression of the spinous processes of the last dorsal vertebræ, whilst those of the upper lumbar apparently projected, in addition to which there was some lateral distortion. The lower extremities were

quite paralysed, and the integuments of

the abdomen devoid of sensation. Mr. Key determined to try and reduce the displacement of the vertebra; accordingly, pillows being placed beneath the belly of the patient, the back was bent over them, but without effect; the man was then placed on his side, with his body bent, a napkin passed under the arms, and one above the ilia, and extension in either direction made by assistants, until the bones resumed almost their natural situaVOL. VIII. No. 15.

27

tion, with a distinctly audible noise. Mr. Key thought the patient was better, but the amelioration was trivial. Cuc.cruent. ad 3 vj.-house-physic. 17th, Much the same lower extremities and bladder paralysed. Little pain. Almond mixture, with 15 grains of the nitrate of potash, thrice a day. Twenty leeches to the back. 19th. Integument of the thigh rather more sensible-tongue furred-pulse quick. The skin becomes discoloured on very slight pressure, so that it is necessary to change the position of the patient frequently. The urine is ammoniacal, and deposits much sediment, on exposing which, with a drop of nitric acid, to the flame of a candle, it is evaporated to dryness, and a bright pink colour left upon the card. This test, indicating the presence of lithic acid, Mr. Key ordered the patient to be kept on vegetable diet, with soda water for common drink. 30th. There has been little alteration, till the last two evenings, when he has been very delirious. From this time the patient became more and more emaciated-sloughs formed on the hips, and, on the 18th of August, he died.

Dissection. The arch and body of the twelfth dorsal vertebra were found to be fractured. The broken arch did not apparently press upon the cord, but an insulated portion of the body had been thrown backwards, so as greatly to compress the sheath. The transverse pro

cess of the first lumbar vertebra was also broken off. There was not much displacement of the column generally, and the portions of the fractured vertebra were much consolidated by the reparative process. The spinal marrow, where pressed upon, was pulpy and soft, and the remaining portion was not thicker than cream. The coverings were not af fected. The bladder presented patches of ulceration, which passed through all the coats, and in the cellular membrane, at its fore-part, was a collection of pus. There was a small abscess in the cortical

portion of the right kidney.—Lancet, 209.

Remarks. We know not what surgeons generally will say to the practice of extension, in cases of fractured spine, but we are pretty sure that Mr. Charles Bell will stare. It certainly does seem an awkward thing to put pillows under a man's belly, and then try to bend his back across them, especially if that back

be already broken; but we see that, in this particular instance, if it did no good, it apparently did no harm. We apprehend, however, that all these little mechanical contrivances are not likely to be so serviceable in fractures of the spine as of the cranium. The machinery of the vertebral column is so complicated, and the parts so dovetailed one with another, that a fracture is rarely the simple thing we meet with elsewhere; and, besides, the patient, for the most part, sinks, not so much from the immediate effects of the injury, as from the inflammation, and consequent disorganization, of the medulla afterwards, or from affection of the bladder.

is efficacious. This operation consists in an incision from one angle of the mouth to the other, along the inner side of the upper lip, and thus, in fact, dissecting away a mass of condensed cellular tissue forming the swelling. The hæmorrhage is very great; but it either ceases spontaneously, or may be restrained by ligature of the bleeding vessels. The operation is very painful, but not dangerous; and it removes a deformity which gives a peculiarly stupid cast of countenance to the individual afflicted with it. For the cases detailed in illustration of the above proceeding, we must refer to the Journal already quoted, vol. 3, 1827.

13. ENLARGEMENT OF THE UPPER LIP. In a recent Number of the Journal de Progrès, Dr. Paillard has drawn the attention of his brethren to the treatment of this peculiar deformity. He observes that this said enlargement is generally considered as an effect, as well as a sign, of scrofula. It usually appears in scrofulous subjects, and in that period of life when scrofula prevails-and it generally disappears when the scrofulous diathesis ceases, or is overcome. But we occasionally observe this phenomenon where there is no scrofula in the constitution, and it sometimes remains as a striking deformity, after the other symptoms of scrofula have entirely vanished.

If, in a scrofulous subject, we examine this swelling of the upper lip, we find the cellular tissue more abundant than natural, and infiltrated with a serous fluid -the muscles more pale and flabby than in a healthy subject-the skin very pallid or shining, and, as it were, infiltrated. Sometimes this swelling is covered with ulcerations, which discharge a matter that forms into scabs, which fall off, and are renewed from time to time. The cellular tissue, then, appears to be the seat of this affection. But the treatment differs, according as the complaint is an indication of scrofula, or independent of that diathesis. In the former case, local treatment is of no avail, and we must cure the local complaint through the medium of the constitution. In the latter case, the local treatment now to be mentioned

14. BARON LARREY ON FRACTURES.

He

By a private communication, we learn that the above-mentioned veteran has projected and makes use of, an extraordinary dressing for fractured limbs. encircles the whole of the member with compresses and bandages soaked in gummy or albuminous substances, which, on drying, form a complete, immoveable, and inflexible case for the injured limb. This he applies, whether the fracture be simple or compound, and never takes it off till the cure is completed, whatever may be the degree of swelling, infiltration, The swelling is either prevented, or subor even suppuration, that supervenes. sides, without danger-the infiltrations or suppurations are absorbed—and the process of re-union goes on safely. We think it not improbable that, in simple fractures this plan may have some advantages over the splints and bandages now in use. ron Larrey's apparatus forms a complete shell or mould that adapts itself to every part of the limb's surface, and thus forms a more permanent and imperturbable case for the member, than any apparatus which can be constructed of splints. There is this advantage, also, that the member is never disturbed by subsequent examinations or adjustments-a frequent source of displacement of the bones. But how far this apparatus will apply to compound fractures, especially where there is much laceration of the soft parts, or shattering of the bones, we will not venture to say. We should suppose that it never can become generally applicable in such cases.

Ba

We understand, however, that some of the Parisian surgeons are adopting the plan of the Baron.-Vide Journal de Progrès, vol. iv.

15. ENDERMIC MEDICATION.

In a former Number of this Journal, we gave some account of M. Lembert's plan of introducing medicinal agents through the pores of the skin. M. Bally has, for three or four years past, followed up the investigation on a larger scale, and has given some short notice of the results in the REVUE MEDICALE, for April, 1827.

He observes that, if any doubts are still entertained respecting cutaneous absorption, the endermic medication might be sufficient to dispel them. Numerous experiments have demonstrated to him the unequivocal power possessed by every part of the body's surface, for taking up, with more or less rapidity, such substances as are applied thereto. The following is a brief summary of his experi

With belladonna applied to the insteps, our author has produced all the phenomena which that medicine is capable of exciting when taken into the stomach, such as extreme dilatation of the pupils, and diminution of vision. The extract of squill, when externally employed, induces perspiration, increases the urinary secretion, and promotes expectoration. The strychnine has been applied through the skin, and was found to affect the locomotive system, without much disturb ing the sensorial functions. In some cases of paralysis from lead, the muscular power has been restored without the production of those violent convulsive succussions, by which patients are sometimes affected under the influence of strychnine when

taken internally. Our author has remarked, however, that this potent substance produces, whether taken by the stomach or through the skin, an evident turgescence about the head, and much flushing of the face, which often render it necessary either to suspend the remedy or take blood from the patient.

The deuto-chlorure of mercury, when used in this way, was attended with some unpleasant circumstances on the surface, although it frequently removed severe pains in the bones and other deep-seated parts. Old syphilitic complaints were entirely cured by the endermic use of mercury. There are some difficulties attendant on this endermic medication, the greatest of which is the necessity for removing the cuticle, in order that the medicinal substance may be absorbed. In those cases, however, where there are still greater difficulties in employing remedies internally, we must not be dethe surface, for the application of the terred by the inconvenience of denuding agent.

Capt. Dubray, aged 29 years, received a severe contusion on his back in the Russian campaign, during the conflagration of Moscow. He did not think much of the accident at the time; but shortly afterwards he began to perceive an inability to retain his urine, which inability increased. On the 15th January, 1821, he experienced, for the first time, some hesitation in his speech, and a few weeks afterwards, he felt some loss of muscular power in his hands. No medical advice was sought till October, 1822, "when he consulted M. Broussais, who drew from the patient the foregoing history. M. Broussais recommended cupping, blisters and fomentations to the spine, and a vegetable diet. This advice was not long followed, and the patient applied to another physician, who ordered a blister to his arm, and prescribed the vapour bath. This last remedy rather aggravated the complaint, and caused congestions about the head. Again, he returned to M. Broussais, and submitted to the antiphlogistic treatment and revulsives. Venesection, leeches, setons, the cautery,

and vegetable diet, were prescribed. By this time the paralysis had extended far and wide. He could scarcely walk, and speech was quite annihilated. He could not retain his urine, whether sleeping or awake. The treatment made little impression on the complaint. It was merely remarked that, after sanguineous emissions, the embarrassment of speech and locomotion was somewhat diminished. The disease continuing its course, M. Dubray fell into a state of apathy the most complete, and was soon incapable of supporting the perpendicular position, or retaining the fæces. Eschars now began to form on the sacrum and hips; yet still the functions of digestion and assimilation went on well, and the patient even acquired corpulency. In the beginning of 1827, the Captain showed symptoms of plethora, which were followed by those of gastro-enterite, of which he died in the month of April, 1827. During this last illness he showed signs of encephalic and spinal irritation, as evinced by convulsive and spasmodic twitchings in various parts of the body, with retraction of the fingers, rigidity of the members, &c. He died on the 24th April, 1827.

Dissection. The arachnoid presented many traces of inflammation-the cerebral substance was injected, but not softened. The same was observable in the cerebellum and tuber annulare. The pia mater and arachnoid of the spinal marrow was injected and red, especially at the inferior portion of the canal. In the cervical and upper half of the dorsal portion the spinal marrow appeared sound, and preserved its natural consistency; but about the middle of the dorsal region, it began to soften, and this softness increased as the medulla was examined downwards, till it ended in a complete bouillie, at the termination of the dorsal region.

There was some disease of the heart and large vessels, but to no great extent, The mucous membrane of the stomach and small intestines was inflamed. The liver was turgid, and the kidneys were degenerated into a fatty mass.

17. REMARKABLE NEVUS MATERNUS. Mr. BENNETT. Med. & Phys. Journ. This case occurred at the Plymouth In

firmary, under Mr. Baldy, Surgeon. A male child was delivered, presenting the following appearances :--The mouth was extended to the utmost limits, and ineapable of being closed, by the existence of a cluster of tumours of various sizes, which occupied and arose from the upper and middle part of the tongue. "The tumour bore, in appearance, an astonishing resemblance to a bunch of grapes, not in form alone, but also in colour." There was another nævus on the back of the thorax resembling the wattle of a turkeycock. The nævi were removed from the tongue six hours after birth, and little or no hæmorrhage ensued.

The most remarkable circumstances are still in reserve-the causes of these extraordinary phenomena.

"Fælix qui potuit rerum cognoscere causas."

When the woman was questioned whether or not she had longed for any particular object during pregnancy, it occur red to her that she had longed for grapes. The turkey-cock's wattle on the back was next accounted for, by the fact of her being frightened by a turkey-cock, when the pregnancy was four months advanced. doubt this explanation, we shall observe As it might be thought uncourteous to in the words of an eminent foreign writer : "La medecine est trop éclairée aujourd'hui, pour ajouter foi à toutes les rêveries débitées sur ce sujet. On sait que des vices d'organisation de la peau, par ces taches, verruës, &c. sont causées par

des alterations dans la distribution des vaisseaux sanguins sur le point altéré, (ce qui fait que beaucoup sont des tumeurs sanguines,) ou par toute autre lesion organique."

18. DENARCOTISED LAUDANUM.

[Dr. HARE, of Pennsylvania.]

It is now generally acknowledged, that the unpleasant effects of opium result from a principle called narcotine by the French chemists, and Robiquet informs us, that this deleterious principle may be separated from opium by digestion in æther. Dr. Hare prepares the denarcotised laudanum in the following manner.

Some opium is to be shaved, by rubbing it on the face of a jack-plane, for example, and then to be subjected, four

times successively to as much æther as will cover it, allowing each portion to be acted upon for about 24 hours. The opium left behind is then subjected to as much duly diluted alcohol as would have been adequate to convert it into laudanum of the common kind, had it not undergone the above process. The tincture thus obtained is the denarcotised laudanum. From the æther was precipitated the narcotine, or noxious principle. The digestion of the opium is conveniently done in a common Pappin's digester, and the æther should be kept near the point of ebullition. Dr. Dewees has tested the denarcotised laudanum in several unequivocal cases, when opium, in all other forms, disagreed, and he found Dr. Hare's preparation free from all bad effects.-Philad. Journal, May, 1827.

19. M. BROUSSAIS' OPINION OF ENGLISH MEDICINE.

We believe we have taken more pains to make the doctrines of M. Broussais known in this country, than any other journalists on this side of the Channel; and we must do the celebrated Professor above-mentioned the justice to say, that he returns the compliment, by seizing every opportunity of making English physicians and English medicine favourably known on the Continent. M. Broussais is decidedly the merriest man in the merriest capital of the merriest country in the world! We have shown, on former occasions, how Tommasini and Broussais formed their judgment of medical literature and practice in this country-namely, by quoting a few eccentric or unknown contributors to monthly journals, and holding up their opinions and attainments as the standard of the whole profession! As they took their texts from quotations in the foreign journals, we supposed they were unacquainted with the English language. We are sorry we cannot, on the present occasion, offer this excuse for the manner in which M. Broussais erects the tribunal of criticism on this nation. He evidently understands our language-quotes direct from our journals-and signs his name to the criticisms.

The EDINBURGH JOURNAL of MEDICAL SCIENCE (now no more) is that on which

the merry Professor of the VAL DE GRACE expends whole torrents of critical wit and satire, interlarded with expressions not quite becoming the politest nation of Europe. Dr. Brown, of Sunderland, is first put on the rack, and we should suppose he has not a single joint left undislolocated! The Doctor has disputed the doctrine of fever being always dependent on local inflammation, whether of the brain or the bowels. For this he is crucified, and treated with the most profound contempt. "Que repondre (says Broussais) à un homme qui confond les affections de plusieurs organes de premier ordre dans une même denomination, sans s'en apercevoir qui isole les affections du systême nerveux des phénomènes vasculaires ?" Again, after quoting another passage from Dr. Brown's paper, he remarks, "Est-il possible de se débattre plus péniblement dans une ONTOLOGIE plus tenebreuse?"

The editors of the Edinburgh Journal also come in for their share of M. Broussais' censure. "Nous avons été étonné du ton de légèreté et de mauvaise foi qui y regne. Les auteurs de ces sortes de propos ne doivent plus mêmes esperer de reussir par ces miserable moyens.'

Mr. Travers next suffers. After criticising the author's doctrines of irritation, M. Broussais pounces on the editor's decision respecting the merits of the work. "A more important pathological work (say they) has not appeared since the days of John Hunter. Mr. Travers is the first who has successfully drawn the line of distinction between the phenomena of irritation and those of inflammation, which have been so long confounded to gether." Upon this passage the following terrible judgment is passed-and the whole of the English faculty is, at one fell swoop, consigned to damnation! "Evidemment le mal est radical chez ces Anglais : tant qu'ils se contenteront d'expressions vagues et générales, tant qu'ils ne sentiront pas la necessité d'aller chercher l'organe malade-c'est-à-dire tant qu'ils seront ontologistes, ils ne comprendront rien à l'importance de la medecine physiologique.”

Dr. Gairdner is then shown up. Our readers know that this gentleman has published some cases of erosion or perforation of the stomach, on which we were induced to pass some strictures, at page 87 of the