junctiva palpebrallis also becomes changed in structure, and a morbid sensibility is generated, which is very difficult of removal. In such cases the disease will continue long after its cause is removed, and then requires a specific treatment. The author next goes on to prove, or at least to support his doctrine, that the affection of the eye is an association with, or consequence of the cutaneous eruption. For the arguments and observations on this head we must refer to the original paper. His principle being admitted, (and we do not see any just cause for denying it) the indications of cure will hinge on the removal of the eruption, and the extinction of the ulcerative process. "Whatever external appearance of active inflammation may exist, provided it be of the specific character, usually attendant on porrigo, and occuring in conjunction with pustules or ulcers of the globe, bleeding either locally or generally is seldom necessary; except, indeed, the inflammation shall have extended to the internal tunics of the eye characterized by pyrexia, severe pain of the eye, forehead, &c. Blistering, likewise, which constitutes so valuable a remedy where a derivative is required in these cases, is not only useless, but generally tends to aggravate the eruptive disease, and thereby proves an additional source of irritation. The cooling sedative lotions in such general use are for the most part unavailing here: the object kept in view in the treatment of this particular affection, being not so much the alleviation of pain and irritation, as the production of a new action, in parts already under the influence of a specific disease. "Corresponding with these views, it has been found by experience, conducted upon rather an extensive scale, in a public institution, where a large proportion of the cases are of this class, that the mercurial applications constitute the best remedies. A weak solution of the oxymuriate of mercury, composed of one quarter of a grain to the ounce of water, forms a very useful application; or if, there be much discharge from the eyelids, and especially if accompanied by excoriation of the parts around the eye, the mixture of calomel and lime water, known by the name of black-wash, will be found to be one of the best local remedies. The unguentum hydrargyri nitratis mitius, or the unguentum bydragyri præcipitati albi, affords an excellent dressing for the eruption, or ulcers about the face and ears, which require to be attended to; a small portion of the former, or the red precipitate ointment diluted, is to be introduced within the palpebræ at bedtime. re Previously, however, to the use of these latter means, a weak solution of the argentum nitratum, in the proportion of two grains to the ounce of distilled water, should be dropt on the surface of the globe, and this ought to be repeated every second day, as long as the ulcers continued.* It has already been marked, that the morbid action has been kept up, in the fine textures of the eye by the presence of an ulcer, or fissure at the corner of the eyelids, which will be frequently observed to bleed, whenever the palpebræ are forcibly separated. These fissures must be touched, every second day, with a saturated solution of the nitrate of silver; and during the intermediate days, with the weak ointment of nitrate of mercury. "The vascularity together with the irritability will generally disappear with the healing of the ulcers, a strong proof that the specific action of these vessels is overcome; but should a degree of morbid sensibility still remain, a collyrium consisting of four grains of the sulphate of zinc, to an equal number of ounces of water, combined with a drachm of the vinum opii, dropped into the eye, once or twice a day, will be found highly useful." On the constitutional treatment, Dr. Willan's work will be consulted with advantage, and also the lectures of Mr. Lawrence, as published in the 10th volume of the Lancet. *We are informed by Dr. Maule, of Marlborough, that "he has found a solution of the argentum nitrat. in the proportion of two grains to the ounce of distilled water, (dropt into the eye twice a day), a safe, not painful, and very powerful remedy in inflammation of the conjunctiva."-Extract from a Letter to the Editor. 3. ST. GEORGE'S HOSPITAL. COMPOUND FRACTURE OF THE THIGH, TERMINATING IN MORTIFICATION.* The patient, a stout muscular man, was admitted under the care of Mr. Rose, with compound fracture of the left thigh, about two inches above the knee-joint. The accident had happened half an hour previously, in consequence of a large wool-sack falling on his shoulders, and felling him to the ground, with the leg bent under him. The fracture was transverse, the wound about an inch and a half in breadth in the same direction, but the fracture seemed to extend down through the inner condyle, where a projection of bone was felt beneath the integument. There had been much hæmorrhage, and the disposition to bleed still continued. Limb to be placed on the double inclined plane-light compress and dressing to the wound-cold lotion, with occasionally ice to the knee-anodyne draught. On the next day, there was a slight attempt at reaction. V. S. ad 3 viij. The limb became much swollen from extravasation-there was thirst, and, in the evening, the pulse had got up to 110, with heat and tension of the integuments of the thigh and knee. Haust. sennæ-V. S. ad 3 viij. Third day. Better in the morning, having passed a quiet night, but at 10, P. M. he became rather delirious, and an emphysematous crackling could be felt on pressing about the thigh. Liq. op. sed. m. xxx. Spt. ath. comp. m. xxx. Mist. camph. 3j. statim. Fourth day. Pain had ceased the leg and foot were cold-the pulse weak; in short, mortification had shown itself. This spread to the groin, the emphysema reaching still higherthe skin assumed a bilious tinge-the countenance became puffy and anxious, he grew semi-delirious, and at 2, A. M. of the sixth day, died. The dissection we shall give in the words of our contemporary. "Sectio Cadaveris, 12 hours after death. -On uncovering the body it presented, certainly, a most extraordinary appearance. It was blown up to at least twice * London Med. Gazette, No. 11, its natural size, and ephysematous from top to toe, whilst even the features were so distorted, that the nearest friends of the patient could scarcely have recognised him. The mortification had extended for some little distance up the abdomen on the left side; the scrotum was like a large green ball; and the penis was discoloured, and in a state of priapism. No attempt at union had taken place in the wound, and on cutting down to the fractured bone it was found to be much shattered. As has been stated, the femur was broken across about an inch and a half above the kneejoint, but from this a perpendicular fracture extended into the joint separating the inner condyle. Splinters of bone were found here and there; the cancelli were gorged with blood, which had also been forced into the vasti, cruræus, and other muscles, but more especially into the parts around the knee-joint, and within it. On cutting into the capsule of the latter, there flowed out a most offensive mixture of grumous blood and sanies, and the cartilaginous surface of the patella and of the condyles of the femur was stained of a dark venous colour, to the depth of a line or more. No injury of the femoral or popliteal vessels could be discovered, but from the quantity and situation of the extravasated blood, it appeared probable that some of the articular, or the anastomotica magna artery, or both, had been torn. The emphysema was found to be seated not so much in the subcutaneous cellular tissue, as in that looser texture which connects and pervades the muscles, &c. It was surprising how superficial the gangrenous disorganization appeared to be above the immediate seat of injury. The cellular texture and the muscles were emphysematous to be sure, but neither the one nor the other showed any trace of disease besides. The muscles indeed were as florid, and seemingly as healthy, as an anatomist could desire. Nothing par ticular, we believe, was found in the abdomen or in the thorax. The head was not examined." Remarks. The above is a good instance of the TRAUMATIC GANGRENE of Baron Larrey, or "local gangrene," described by Mr. Guthrie in his very excellent work This form of upon gun-shot wounds." gangrene, it is well known, may arise from two causes, 1st, defect of power in HUMORAL PATHOLOGY. the limb from wounds of the great vessels 4. STRASBURGH LYING-IN HOSPITAL. which supply it, or destruction of its textures; and, 2dly, from excess of inflam matory action kindled up after slighter injuries. Mr. Guthrie, in his work cited above, mentions two or three cases of the first species, in which he amputated with success, no line of separation having formed. Sir Astley Cooper, if we remember aright, details two cases of traumatic gangrene, in which amputation, under the same circumstances, was successfully performed, and strongly recommends the practice. A year or two ago a case occurred to Mr. Brodie at St. George's Hospital, where compound fracture of the bones of the leg, and that not a very severe one, was followed by mortification of the limb. Mr. B. amputated the thigh, without waiting for any line of separation, but unfortunately tetanus supervened and carried off the patient.* In the present case, it appears that amputation was proposed to the patient at the time of his admission, but he refused to submit to it. It was not again proposed, says the reporter, upon the first appearance of the mortification, first, because it was thought that he would not consent, and, secondly, "because the chance of success was then necessarily desperate." Now, really, we do not conceive these reasons of the reporter's to be particularly godd ones. As for thinking that the patient would not submit to it, that was neither here nor there, for a few minutes' conversation with him would have settled the point. A man may refuse to submit to an operation in the first instance, because he is not aware of the extent of the injury; but when he finds his limb turning black and blue, in other words, mortifying, he may become alarmed, and refuse consent no longer. Again, the chances of success, we are told, were "necessarily desperate," but all we can say is that there are several cases upon record where amputation saved the patient. The chances are not very great, to be sure, but still we do not see why they should be "necessarily" desperate. *This case was published by us at the time, and may be found fully detailed at page 219 of our 13th number. The following curious case is reported by M. Stoltz, from the Strasburgh Lying-in Hospital. A female, aged 20, was admitted into the CLINIQUE, on the 28th May, 1826, being then in the eighth month of hes second pregnancy. On the 23d July, pains of an intermitting character came on in the loins, and were considered parturient. But no dilatation of the os uteri took place, and, on the 15th, she was still in pain. 16th. Febrile symp toms set in, and, in the evening, red spots appeared on various parts of the body, some of them being elevated, and giving rise to the suspicion that they were of the varioloid character. 17th. A good deal of blood came away in the urine, and a petechial eruption was evident over the members, trunk, and inside of the mouth, even on the tongue. The breathing was slow and laborious-there was a sense of constriction in the throat-febrile beat of skin-small, quick pulse-vertigo-great debility. These symptoms increased, and she died next day delirious. At this moment, M. Stoltz was called in, and although no motion of the fœtus had been observed since the 16th, he determined on the Cæsarean operation. But the child was evidently dead some days, for the epidermis readily detached itself from all parts of the body. Over the surface of the mother, the same petechial spots still existed, and were seen on the tongue, and the conjunctiva of the eye. There was nothing particular in the head. The lungs were covered with petechiæ, and much blood and mucus flowed from incisions into their structure. The pleura, the surface of the heart, the exterior of the large vessels, the peritoneal covering of the stomach, intestines, spleen, and kidneys, all presented petechial ecchy moses. The internal surface, also, of the pelves of the kidneys showed petechiæ, and a quantity of blood. On the surface of the foetus, there were no petechiæ; but the lungs were covered with them, as were the pericardium, heart, and origins of the large vessels. The blood, both in the mother and fœtus, was entirely liquid, and of a violet colour. There were no coagula in any part of the venous or arterial systems of either of the bodies. >We think there can be little doubt that, in this case, the physical phenomena presented by the foetus proved the identity of disease in the mother and child. Petechiæ were found in both bodies-and, in both, the blood was in the same dissolved state. After this can any one doubt the communication between mother and foetus-although no injections can be made to pass-no nerves can be traced? 5. HOPITAL DE MONTPELLIER. M. BOYER AND M. DELPECH ON PILIMICTION. We lately noticed some curious instances of "bodies foreign in bodies natural," as adduced by Messrs. Brodie and Bell. Under the somewhat eccentric term of "PILIMICTION" (the meaning of which is obvious enough) M. Boyer has brought forward some remarkable examples, in the Royal academy of Medicine. Case. 1. A female, (the wife we presume, of a medical man) at the age of 25, and in her second pregnancy, became af fected with irritation in the bladder, and voided frequently some hairs with her urine (pilimiction.) After some time, her husband (in the presence of M. Delpech) extracted from the patient's bladder, by means of an instrument, a mass of hair, of considerable size. Several other extractions were subseqnently performed. But, at length, she came into the hospital of Montpellier, and M. Delpech, having first dilated the urethra, was enabled to reach the bladder with his finger, and extract a large ball of hair. The patient continued well for two years, at which period, she evinced symptoms of stone in the bladder, and M. Delpech removed a calculus, the size of an egg, the nucleus of which was a piece of skin, covered with hair, and containing a portion of zigomatic bone! M. Delpech explains this case, by supposing that the debris of an imperfect fœtus, had made its way through the parietes of the uterus or ovaria into the bladder; and, indeed, we cannot see any other rational explanation of the phe nomenon. Case 2. By M. La Riviere. A lady, 58 years of age, had complained, for sev eral ycars, of a sense of weight in the lower part of the abdomen, with difficult micturition, and great pain in the region of the bladder. Mr. Gille, surgeon of the Hôtel Dieu, sounded her and struck upon a tumour, which_burst, and discharged a large quantity of matter. The pus continued to flow in considerable quantities, with the urine, for eight days when fever supervened, with diarrhoea, vomiting, and sweats. The case ended fatally. On dissection, the uterus was found adherent to the bladder, and in this adherent portion were found several pieces of bones, and also some hairs, in a kind of cyst, from which the pus had issued into the bladder. The celebrated Meckel, indeed has collected, in an interesting memoir, the most remarkable examples of masses of hair found in different parts of the human body. He quotes from Schenk, Horstius, Hilda nus, Tulpins, and a multitude of others, various cases of masses of hair passed from the bladder, but no dissections have proved that they originated in that receptacle. We have no doubt that they proceed, in all cases, from the uterus, the fallopian tubes, or the intestinal canal. 6. LA CHARITE. INFLAMMATION AND SOFTENING OF THE MEDULLA SPINALIS. [M. Bayle. La Charité.] The following very interesting case will be found to illustrate and confirm some important physiological and pathological discoveries of recent date. Case. Agustus Barre, aged 20 years, by trade a shoemaker, ricketty from his infancy, but having enjoyed good health, became affected, about the middle of December, 1825, with pain in the left side of his neck, which he attributed to cold, and to which he paid little attention for several months, when it gradually increased, and at length impeded him in his trade. At this time also Barre began to feel a weakness, accompanied with flying pains in his arms. He had leeches applied to his neck, took vapour baths, and some medicines, with slight amelioration of the symptoms. On the 15th April, 1826, he was received in LA CHARITE, complaining of the pain in his neck, which prevented him from turning his head, and also of pain and weakness of the left arm. The complaint was con sidered rheumatic, and leeches, blisters, low diet, and some topical applications were employed, with trifling effects. He now complained of pain in his head, while that in his neck became aggravated. On examination, a diffused swelling was observed on the left side of the neck, which was treated unsuccessfully by linaments and other outward applications. Towards the latter end of May, the cervical pain had much increased, and evidently extended itself to the head, especially to the frontal region. The left arm first, and subsequently the right became gradually paralytic, and by the end of June they were both completely incapable of motion, while their sensibility was in a state of perfect integrity. The left lower extremity came into the same state, and soon after the right leg lost its muscular power, retaining its sensibility. The intellectual faculties were yet untouched; but the speech was embarrassed, and the patient complained of difficulty of breathing, and a feeling as if the chest were compressed. The respiratory murmur was heard throughout the thorax, but louder in the right side. The patient now emaciated fast, and there was occasionally an acceleration of the pulse. During the first four days of July, he evinced incoherency of ideas, with complete delirium at night. He died on the 4th July. Dissection, 36 hours after death. The tumour on the left side of the neck was first examined. It was rather firm, and appeared to have a deep-seated base. After removing the integuments, and raising the sterno-cleido muscle and pneumo-gastric nerve, an abscess was discovered opposite the transverse processes of the cervical vertebræ, the size of an egg, containing yellow and thick matter. When a probe was passed into the abscess, it penetrated into the spinal canal. The vertebral column was then laid open throughout its whole extent. The posterior columns of the medulla spinalis were found softened to the consistence of cream, from the first cervical vertebra to the third or fourth dorsal. This softening or diffluence was greatest at the surface, and gradually diminished as the centre of the chord was approached. The anterior portion of the spinal marrow was slightly softened also, but infinitely less so than the posterior. About the middle of the cervical region, two small holes were found in the bodies of the vertebræ leading to the external abscess. The transverse processes were here carious. In the head, the arachnoid was found greatly injected, and adherent in some places to the pia mater, as was the latter to the substance of the brain. The brain itself and cerebellum were sound.. The right lung was gorged with blood, especially posteriorly, where it was also hepatized, and there were numerous tubercles scattered through its substance. The left lung was more crepitous and free from disease. On opening the abdomen, they were surprised to find four perforations of the stomach-some of them an inch in diameter. Near these perforations the mucous membrane of the stomach was thinned away or entirely obliterated. Remarks. M. Martinet thinks that the external swelling and abscess were only consequences or prolongations of inflammation of the spinal marrow-and, in fact, that the matter had made its way outwards through the holes in the carious vertebrææ. This, he thinks, is proved by the fact that, from the very beginning, the patient complained of weakness and flying pains in his arms. We confess we have some doubts whether the matter of the abscess made its way inwards or outwards. The extension of inflammation from the intermuscular swelling to the interior of the canal (a thing not unlikely) might occasion the early symptoms abovementioned. Nay might not the swelling on the neck affect the nerves issuing from the spinal column, and produce the early phenomena? Be this as it may, there can be no doubt of the existence of inflammation of the medulla spinalis, whether primary or secondary-and of the softening or diffluence being a consequence of this inflammation. We observe that, as soon as this disorganizing process had made a certain progress, the upper and one of the lower extremities were stricken completely paralytic, their sensibility, however, remaining entire-a pathological fact which beautifully illustrates and |