turbance of the system. Having sounded, &c. Mr. Wardrop, assisted by Mr. Lawrence, proceeded to the operation, which was performed with a common staff, having a deep groove, and a large scalpel with straight and rounded back. The incision of the prostate not being sufficiently free, it was necessary to introduce the knife twice to enlarge it, when a stone, weighing above an ounce and a half was extracted. When put to bed, he had a severe rigor and much pain, for which he took a large opiate. Vespere. Very low-pulse 100, small; and fluttering-pain in the abdomen and wound, through which the urine passed freely. Another large opiate. In the morning, the countenance was sunken and anxious-the pulse 140, but weak and fluttering-much internal pain, with tenderness of the abdomen. A large opiate was again given, with camphor and ammonia, but the patient continued to sink, and expired next morning. Dissection. The bladder was greatly contracted, and the incision into it remarkably large. The peritoneum, generally, was vascular, particularly over the fundus of the bladder, where there was recent coagulable lymph, exactly resembling thick pus. The left kidney bore very decided marks of ancient inflammation.-LANCET, 208. Remarks. It is evident that this patient sunk, not so much under the local inflammation, as in consequence of the shock given to the system generally by the operation. These cases, as Mr. War drop justly observed, are exceedingly difficult to treat-you dare not deplete for fear of the exhaustion-you are afraid to stimulate because of the inflammation. But might not the local action have been moderated here by local means, leeches, fomentations, &c. whilst at the same time, the system was supported by the camphor and ammonia? We think so, ough we are quite ready to grant that dds were fearfully against recovery, er treatment was employed. The makes a very silly remark. He hat he was particularly struck, with the facility with which may be extracted by on, after the incisions iently free! This is nsidering that, in obliged to em ploy repeated introductions of the scalpel, before the incisions actually were "sufficiently free" 10. ON EXTIRPATION OF THE UTERUS.* By Dr. GUSTAVUS HESSE. This operation, though one of the most formidable in surgery, has been practised for centuries past-and more frequently by ignorant or audacious Charlatans, than by regular surgeons. A German surgeon, however, (M. Osiander) rescued this operation from the hands of quacks, but, unhappily, he could never be prevailed on to give the details of his practice to the world at large. He simply stated, from time to time, that he had performed the operation, and promised a book on the subject; but he died at an his cases-at least, that are available by advanced age, and has left no records of the profession. Osiander's operation was seldom imitated till of late years, when several cases have been published of partial and even of total ablation of the womb. It would be wrong to form too sanguine hopes from this operation, especially in cases of cancer uteri; but the experience of Osiander enabled him to aver, that extirpation of scirrhous uterus was as successful as extirpation of that disease in other parts of the body. All of his patients recovered from the immediate effects of the operation, though some of them relapsed afterwards, and died of the renewed malady. This operation (extirpation of the uterus, is said to have been performed in a relates nineteen cases; and Schenk a far great many instances formerly. Baukin greater number. But it is justly doubted, whether many of these were not partial amputations of the organ, or removals of polypi, which had been mistaken for enlargements of the womb. Baudelocque, that the extirpation of the uterus had however, considers it as incontestible, been successfully executed before his time. The operation has been performed *Allegemane Medezin. Annalen. May, 1826. frequent in the female than in the male. It is thought that it is sometimes owing to hereditary disposition, as it is found that the children of parents who have organic diseases of the heart, are apt to be similarly affected. There are some other predisposing causes enumerated, but we do not deem it necessary to notice them. On dissection of subjects who die of this disease, we generally find the venous system of the brain gorged with blood, the ventricles distended with serum, and one or both phrenic nerves swollen and indurated, or else in a state of atrophy. In the heart, the foramen ovale is open. The blood throughout the whole system is found quite liquid-the lungs partially ulcerated the liver enlarged. The cure of the disease is beyond the reach of art, since we cannot remedy the malformation of the heart, on which it mainly depends. But the author thinks that something might be done by getting the individual past the period at which the disease usually terminates fatally. This is to be done by the greatest repose -by avoiding aliment of a hydrogenated quality-by living chiefly on vegetables and water, &c. And as the oxygenation of the blood in the lungs is very imperfectly performed, this defect is to be remedied as much as possible by solicit ing the action of the other secretory organs with which the lungs are in accord ance, as the kidneys, liver, skin, &c. At the same time, the respiratory organs are to be guarded by the greatest attention to a regulated temperature, and defending them from catarrhal affections. We shall now give some particulars of a case in illustration of this formidable disease. Case. A. Gotlieb, aged 16 years, was said to have enjoyed good health till the year preceding, when he became affected with pains in the left side of the chest, dry cough, dyspnoea, and fever. The vil lage barber was called in, who practised e large bleeding from the arm. This mer sure diminished the pain in the sid but the other symptoms continued same. On the 28th January, the te day of the illness, the author was ca în. He soon discovered the radical d in the central organ of the circulat as evinced by the usual symptoms anose, described above. The pain side had now returned, and the difficulty of breathing amounted almost to orthopnœa. The fever was slow, the expectoration mucous, the appetite gone. Quietude, aqueous drink, and vegetable diet, were prescribed; while digitalis, nitre, hyosciamus, &c. were ordered. In a few days, the oppression and pain were diminished, but the expectoration had become sanguinolent, and the fever was increased every evening. Eight grains of calomel were given night and morning, in order to procure stools. 3d. Feb. The expectoration is now pure blood; but the cough and oppression are somewhat relieved. Acids were given, and a tepid muriatic acid bath ordered once in 48 hours. By these means the hæmoptysis was checked; but purulent expectoration succeeded. On the 26th March, there was another discharge of blood from the lungs, and life was threatened. Venesection and acids again stopped the hæmoptysis; and again the purulent expectoration became copious. The disease now made rapid progress, and the patient was carried off early in May, having evinced for some time, considerable disturbance of the cerebral system. turbance of the system. Having sounded, &c. Mr. Wardrop, assisted by Mr. Lawrence, proceeded to the operation, which was performed with a common staff, having a deep groove, and a large scalpel with straight and rounded back. The incision of the prostate not being sufficiently free, it was necessary to introduce the knife twice to enlarge it, when a stone, weighing above an ounce and a half was extracted. When put to bed, he had a severe rigor and much pain, for which he took a large opiate. Vespere. Very low-pulse 100, small, and fluttering-pain in the abdomen and wound, through which the urine passed freely. Another large opiate. In the morning, the countenance was sunken and anxious-the pulse 140, but weak and fluttering-much internal pain, with tenderness of the abdomen. A large opiate was again given, with camphor and ammonia, but the patient continued to sink, and expired next morning. Dissection. The bladder was greatly contracted, and the incision into it remarkably large. The peritoneum, generally, was vascular, particularly over the fundus of the bladder, where there was recent coagulable lymph, exactly resembling thick pus. The left kidney bore very decided marks of ancient inflammation.-LANCET, 208. Remarks. It is evident that this patient sunk, not so much under the local inflammation, as in consequence of the shock given to the system generally by the operation. These cases, as Mr. War drop justly observed, are exceedingly difficult to treat-you dare not deplete for fear of the exhaustion-you are afraid to stimulate because of the inflammation. But might not the local action have been moderated here by local means, leeches, fomentations, &c. whilst at the same time, the system was supported by the amphor and ammonia? We think so, lough we are quite ready to grant that e odds were fearfully against recovery, tever treatment was employed. The rter makes a very silly remark. He yes, that he was particularly struck, case, with the facility with which erst stone may be extracted by operation, after the incisions made sufficiently free! This is ortunate, considering that, in se, they were obliged to em ploy repeated introductions of the scalpel, before the incisions actually were “sufficiently free" 10. ON EXTIRPATION OF THE UTERUS.* By Dr. GUSTAVUS HESSE. This operation, though one of the most formidable in surgery, has been practised for centuries past-and more frequently by ignorant or audacious Charlatans, than by regular surgeons. A German surgeon, however, (M. Osiander) rescued this operation from the hands of quacks, but, unhappily, he could never be prevailed on to give the details of his practice to the world at large. He simply stated, from time to time, that he had performed the operation, and promised a book on the subject; but he died at an his cases-at least, that are available by advanced age, and has left no records of the profession. Osiander's operation was seldom imitated till of late years, when several cases have been published of partial and even of total ablation of the womb. It would be wrong to form too sanguine hopes from this operation, especially in cases of cancer uteri; but the experience of Osiander enabled him to aver, that extirpation of scirrhous uterus was as successful as extirpation of that disease in other parts of the body. All of his patients recovered from the immediate effects of the operation, though some of them relapsed afterwards, and died of the renewed malady. Dr. P. objected to the former, but acquiesced in the latter. This new consultant attributed the gentleman's complaint to un vice vénérien," although he had not been in the way of any poison of this kind for ten or fifteen years! M. Potain thought, on the contrary, that there was some inflammation about the spinal cord, and that, consequently, the patient's life was in jeopardy. This opinion was not at all participated by his colleague, and the patient determined to put his trust in the latter. M. P. therefore, withdrew. Six days afterwards, M. P. was summoned to meet in consultation, to which were added M. Segalas and M. Dupont. The patient was found incapable of moving himself in bed. The pulse was quick, but the skin was not hot-evacuations could only be procured by injectionsand the urine, which contained puriform matters, was obliged to be drawn off by the catheter In fact, the poor patient was in a state of almost complete paralysis. Messrs. Segalas and Dupont coincided with M. Potain in opinion, and the liberal consultant above-mentioned could only be envied, we think, by a man marching solemnly to the new drop. All the measures proposed were resolutely resisted by the liberal doctor, and, in 24 more hours, the scene closed. Dissection. At this disagreeable part of the business, the LIBERAL did not attend. M. Dupont, however, was witness to the dissection. The spinal column was laid open throughout. From the fifth cervical to the eleventh dorsal vertebra, the membranes of the spinal canal were seen to be intensely inflamed, and covered with a sanguinolent effusion. The membranes were also thickened. The spinal marrow itself was similarly inflamed, and for a similar space. It was also softened in consistence. The time occupied by this tedious dissection prevented an examination of the other parts of the body, as the priests now broke in, and immediately removed the corpse. REVUE MEDICALE, detrimental, he had no right to allow his sentiments to become known in any manner to the patient or friends, unless the first practitioner obstinately refused to hearken to his suggestions. Remarks. Two of the members of the Royal Academy of Medicine were ordered to report upon this curious and melancholy case, and the said reporters have learnedly discussed the question, whether the spinal inflammation was owing to the repeated attacks of intermittent fever, or to the rheumatism. They decided that it was to the latter, this phlogosis of the medulla spinalis and its membranes was to be attributed. For our own parts, we do not see any decided proofs that either of these maladies was the primary cause of the fatal inflammation above-mentioned; but, of the two, we should be inclined to take the intermittent as the most prob able cause. This is the opinion of the original writer of the case, M. Potain. We were not a little surprised to find that no notice was taken by the Academy of the flagrant violation of medical etiquette and common ethics, committed by the second consultant in this case. It was an essential and important part of their duty to animadvert, in the strongest terms of reprehension, on his conduct. Indeed, it is a great pity that there is not some honourable tribunal to appeal to on such occasions. If our colleges and corporate bodies looked to any thing but their own private interests, they would take especial cognizance of all breaches of medical decorum and propriety in the classes of medical society over which they preside -or pretend to preside. But this seems to be no concern of the DIPLOMATIC Corps. A formal, and often an imperfect examination of the candidate, is all the trouble they take the other part of the ceremony, the reception of the fee, is quite a pleasure. The PRESS, however, will probably rouse them from their balpublic opinion may, perchance, so shake cyon slumbers-and the rising gale of the fig trees under which they placidly repose, as to disturb their "Golden visions and romantic dreams." 2. HYPOCHONDRIASIS cured by Ague. The subject of this curious complaint was a gentleman, 55 years of age, meagre, nervous, and endowed with great sensibility of the digestive organs, (doué d'une vive sensibilité des organs digestifs,) which sensibility was less in cold, and greater in warm weather. In the hot season of the year, he was teased with sense of distention in the stomach and bowels, loss of appetite, and tedious difficult digestion. As the winter approached, these symptoms diminished. He was fond of hunting, and pursued the exercise both in Summer and Winter. He had been subject to the above symptoms for some years previous to the date of report; but they had considerably yielded to time and very trifling means, when, during the Lent of 1824, he determined to live in the most rigid forms of that religious fast, subsisting chiefly on fruit and vegetables. At this time, also, he met with some moral afflictions, and the consequence of both these causes was a state of sombre and morose melancholy. He shunned society -became possessed of the most triste ideas-passed his nights without sleep, or in frightful and troubled dreams. In this state he was, as usual, advised to cheer up enter into society-and make himself happy-things easily said, but not so easily done! In short, this gentleman became completely hypochondriacal. In July 1825, he consulted M. Bonnardiere, his morale being consider ably improved, but the physique in a very depressed condition. The digestive functions were gradually impaired-he had pain and weakness in his ankles and wrists, with various other unaccountable ailings. M. B. now administered the cinchona in powder, by which medicine the appetite was restored, and the mind greatly relieved. He entered into society, and began to partake of his usual active exercises. In one of these, he over-exerted himself, and the whole of the dyspeptic symptoms returned, together with the hypochondriasis. On the first days of August, the patient had some febrile movements in the system, and became so weak that he could not walk without the aid of a stick. In fact, a marked intermittent fever was established, and our author, borrowing a hint from Hoffman, determined to let the fever take its course, for some time at least, with the hope that it might cure the hypochondriasis. During this experiment, there appeared some indications of mischief obtaining in the liver, as evinced by pain, tenderness, and some degree of fulness in that region the strength was rapidly reduced by each paroxysm—and the Doc tor, on the 17th of the above month, considered it unsafe to withhold any lon ger the quinine, which was accordingly administered. By the 24th, the period of the paroxysms was only marked by a slight cough and a loss of voice; on account of which it was not deemed neces. sary to interrupt the quinine. In the be ginning of September the patient began to recover strength and spirits. He now took gradually increased exercise, and his appetite and digestion improved, and his amendment, corporeal and mental, was such as to surprise his friends as well as the doctor. Some months afterwards, he had a relapse of the intermittent, but not of the hypochondriasis, which soon gave way to the sulphate of quinine. He has since remained quite free from his hypochondriacal ailments, and enjoys perfect health -N. Bibliot. Med. 3. GANGRENE OF THE FEET FROM Case. Count C, aged 66 years, of athletic constitution, keen appetite, and a very hearty eater, had always kept himself in a state of plethora, with tendency to cerebral congestions and gastric irritation. From these affections he was usually relieved by sangnineous deple tion, especially leechings; but his appetite being too powerful, he was never sufficiently guarded in his diet. In the Autumn of 1826, the Count became subject to an unpleasant sensation of heat |