confirms the experiments of Bell and Magendie; for it was seen that the posterior portions or columns were disorganized, from which portions the nerves of motion arise. The delirium which supervened during the last four days of the patient's life, left in the membranes of the brain the proper signs of its existence-or rather the cause of the phenomenon. The perforations of the stomach are not so easily accounted for. Were they ante-mortem or post-mortem disorganizations? It will probably be said that these lesions and destructions of the coats of the stomach could not have taken place during life, otherwise they would have been attended with corresponding symptoms. But it is to be recollected, that the delirious state of the

patient, for four days, might possibly mask the affection going on in the stomach. The explanation of this remarkable phenomenon, indeed, is not very easy on any hypothesis.-REVUE MEDI

CALE.

The above case, we think, will bear upon and help to illustrate the case lately published by Mr. Iliff, and noticed at page 192 of this Number. We imagine that it will hardly be contended, after this, that Mr. Iliff's patient laboured under no inflammation of the spinal marrow anterior to the diffluence of that organ, and the complete loss of all its functions.

Before we quit this subject, we may be permitted to notice another curious case, related by M. Martinet, in the same hospital report. A young gentleman had experienced, for twelve or fifteen days, an intense head-ache, principally at the bottoms of the orbits, and then was seized with delirium, fever, agitation and occasional vomitings. He was twice bled, and blisters were applied to the feet. On the fourth day from this accession, the patient appeared to be fast approaching the final goal, and had the rattles in his throat. In this state eight grains of emetic tartar were administered. From that moment the patient's agonies seemed inexpressible, and he died the next day.

pearance of pus, being soft, yellow, and nearly liquid. The same was seen in the fissura magna, and several other parts of the brain's superficies. The pia mater was every where intensely injected. On opening the abdomen, the stomach was found perforated in two places, and a quantity of brownish fluid extravasated. One of the openings was an inch in diameter. Around these openings, the parietes of the stomach were very much attenuated, and somewhat reddened. But the general surface of the stomach was pale. All the other organs were sound.

This last case shows to what a pitch of disorganization even the brain will sometimes go, without corresponding symptoms during life. When we say corresponding symptoms, we mean as to duration. We can hardly wonder at the perforations in the stomach, after a dose of eight grains of tartar emetic administered to a patient in articulo mortis! Had the physician applied this medicine to his own skin, he would soon have found out the irritating qualities of the drug.

7. HOSPICE GENERAL. EXTIRPATION OF A "SARCOCELE," FOLLOWED BY TETANUS.*

Tetanus has, we believe, occasionally, though very rarely, followed amputation of the testicle, but in such instances it has generally been referred to the surgeon's having comprised the cord, vessels, nerves, and all, in one ligature. In the case we are going to detail, this was not done, but other violence was inflicted on the cord which would seem to account for the tetanic symptoms.

Case. Muyart, æt. 37, who had led a drunken, dissipated life, and suffered from venereal complaints, received a blow on the testicles in the beginning of 1823. No swelling ensued, but in January, 1825, he applied at the Hospice General, (of Rouen, we believe) suffering from considerable pain with some swelling, and induration of the left testis. In spite of the means employed (no mercury was

* M. Couronne. Revue Medicale, Sept. 1827.

used) the swelling progressively increased, whilst the pain, pari passu, diminished. Towards the commencement of July, M. Couronne conceiving the case to be one of sarcocele, and not likely to be benefitted, proposed the operation to the patient to which he readily consented. A moderate incision was first made into the tunica vaginalis to be sure that it was not a hydro or hematocele, but not a drop of fluid was found in its cavity. The removal of the testicle was then completed in the usual way, but, on dividing the cord, the upper portion retracted within the inguinal canal. The retraction, however, was not permanent, for alternately it appeared and disappeared, evidently depending on the irregular contraction of the cremaster muscle. In order to tie the vessels, it was necessary to seize the end of the cord by the forceps and draw it out which occasioned very severe pain running up to the loins of the same side.

On examination of the tumour, it was found to be of a mixed character, some portions resembling scirrhus, others the medullary sarcoma, with, here and there, small cysts containing fluid as in what is commonly, though not very correctly, called "hydatid disease of the testicle."

A good deal of pain remained for some time after the operation, but, in the course of a day or two, it subsided, apparently in consequence of a certain degree of bleeding which had taken place. On the 10th day, there came on some stiffness of the lower jaw, and on the 12th, there was decided trismus. Complete tetanus followed, which was treated by bleeding, laudanum, the warm bath, mercurial frictions, &c. and, on the 16th day, he was a good deal relieved. This was the 29th of July, but on the 30th, a change for the worse took place; the jaws were permanently locked-the muscles of the abdomen, arms, and neck, rigidly contracted-deglutiton almost impossible-great anxiety, pain in the loins, and insomnium. Convulsions, and loss of consciousness came on, and, on the 3d of August, the patient died. The wound during this time, so far from taking on an unhealthy appearance, had gone on rapidly cicatrizing.

Sectio cadaveris. There was some emphysema beneath the skin, and amongst the muscles of the back and neck. The

The

substance of the brain was a little injected, and a trifling quantity of bloody serum was found in the ventricies. tunica arachnoides of the cerebellum was quite opaque, and the substance of the cerebellum itself softened throughout, and reduced at its circumference to a semi-fluid bouillie, of a yellowish grey colour. The medulla oblongata was unaffected, but the spinal marrow, in its upper half, presented striæ, and patches of red in its substance. The spinal dura mater, was much reddened on its inner surface, and between it and the bony canal there was discovered a considerable quantity of bloody serum. In the left side of the thorax there was some effusion, and the lower lobes of the lung were exceedingly small and filled with dark coloured blood.

We suppose, for we know of nothing better that can be offered, that the cause of the tetanus in this case, was the violence done to the cord by dragging it out, which produced, at the time, and indeed for a day or two afterwards, very considerable pain. This may have been the cause, or it may not, for the truth is that we know little or nothing of either the etiology, pathology, or treatment of these terrible convulsions of the nervous system. The cicatrization of the wound during the progress of the tetanic symptoms is a curious but not very uncommon circumstance, and it proves that these latter are not dependent, as some would have us believe, merely on a kind of error loci.

8. GLASGOW INFIRMARY.

CASES OF EXTENSIVE BURN, TREATED WITH COTTON.*

Case 1. John Cunningham, æt. 25,

* Surgical Report from the Royal Infirmary of Glasgow. By I. H. Plymsoll, Esq.*

*Having accidentally learnt that a severe burn in this metropolis had been very successfully treated, by a method little known in this country, though employed a good deal in America, we have much pleasure in laying before our readers some authentic facts relative to this mode of treatment, from the Royal Infirmary of Glasgow.-ED.

labourer, was admitted into the Glasgow Royal Infirmary, March 3d, 1827, under the care of Dr. Anderson, in consequence of a burn which he had received, a few hours previously, from the explosion of gas in a coal-pit Face and upper extremities were burned to a great extent, and in a state of complete vesication Sweetoil was applied immediately after the accident Injured parts to be dressed with finely-carded cotton. 12th. Cotton has been removed, and burned surface looks healthy, and partially cicatrized. Has been frequently burned before, but never felt so easy as under the present treatment previous burns caused great disfiguration of countenance, which has been entirely obliterated under the application of the cotton. April 4th. Burned surface completely cicatrized-health good. Dismissed, cured.

Case 2. Alexander M'Kinlay, æt. 21, labourer was admitted into the infirmary, April 16th, 1827, under the care of Dr. Anderson, in consequence of a burn which had been inflicted, as in the former case. Face, right arm, and middle third of legs, are vesicated: sweet oil was applied immediately after the accident. Complains of severe pain on injured surface. Injured parts to be dressed with cotton-wool. Has been much easier since the cotton was applied. 26th. Continues free of uneasiness, and sleeps well. June 12th. Barned surface entirely cicatrized, and without contractions. Cured.

Case 3. John Nudgent, æt. 23, labourer, was admitted into the Infirmary, Nov. 22d, 1827, under the care of Dr. Anderson, with an extensive burn, which he had received, three days previously, in consequence of his clothes having caught fire. Almost the whole extent of back, right side of abdomen, right and left thighs, knees and upper part of legs, and left elbow, are most severely burned. Burned surface is covered with a leathery slough, excepting here and there, and on right thigh, where there are vesications. Around the edges of slough skin is red, and, in some places, vesicated. The sloughing parts were bathed with the spirits of turpentine, and, afterwards, covered with cotton wool and bandages. 23d. Has been easier since the cotton was applied than at any time since the receipt of the injury,

The sloughs were altogether separated after the third or fourth dressing, and expose a healthy granulating surface, granulations having afterwards become rather prominent. Patent lint, soaked in a solution of the chloruret of lime, and covered with sheet lead, was afterwards applied. This had the effect of bringing the granulations almost on a level with the adjoining skin; but new skin suffered from pressure-the patent lint and lead were, therefore, discontinued, and cotton was again applied, with increased presFrom this time he progressively recovered. New skin continued to form rapidly. Has been free of uneasiness, and slept well every night, since admission. Injured surface is now almost completely cicatrized.

sure.

Case 4. Daniel Lochrie, æt. 50, labourer, was admitted, Nov. 25, 1827, under Dr. Cooper, having, a few hours since, fallen into a vessel containing a quantity of boiling soda ley. Head and face, and superior part of thorax and upper extremities, were burned. Injured parts are vesicated, and extremely painful -eyelids are swollen, and conjunctiva inflamed :--Dressed with cotton-wool. Dec. 1st. Cotton has been removed from left arm, on account of discharge-parts were found doing well. Jan. 20th. Injured surface cicatrized through its whole

extent.

Observations. These cases are remarkably illustrative of the advantageous consequences resulting from the application of cotton to burns, and, in conjunction with other cases which have been treated, of late, in this infirmary, almost equally severe, and terminating equally successful, have considerably influenced the determination of the surgeons to this hospital, in the treatment of these injuries, so that the practice has, ultimately, become established. The application of cotton to burns originated in America, where, I understand, it has been practised exclusively in superficial burns. It has been introduced in this country by Dr. Anderson, of Glasgow, who has constituted it a most important innovation in the treatment of these injuries. Dr. Anderson has practised it extensively, both in superficial and deep-seated burns; and, convinced of its decided superiority over

1

used) the swelling progressively increased, whilst the pain, pari passu, diminished. Towards the commencement of July, M. Couronne conceiving the case to be one of sarcocele, and not likely to be benefitted, proposed the operation to the patient to which he readily consented. A moderate incision was first made into the tunica vaginalis to be sure that it was not a hydro or hematocele, but not a drop of fluid was found in its cavity. The removal of the testicle was then completed in the usual way, but, on dividing the cord, the upper portion retracted within the inguinal canal. The retraction, however, was not permanent, for alternately it appeared and disappeared, evidently depending on the irregular contraction of the cremaster muscle. In order to tie the vessels, it was necessary to seize the end of the cord by the forceps and draw it out which occasioned very severe pain running up to the loins of the same side.

On examination of the tumour, it was found to be of a mixed character, some portions resembling scirrhus, others the medullary sarcoma, with, bere and there, small cysts containing fluid as in what is commonly, though not very correctly, called "hydatid disease of the testicle."

A good deal of pain remained for some time after the operation, but, in the course of a day or two, it subsided, apparently in consequence of a certain degree of bleeding which had taken place. On the 10th day, there came on some stiffness of the lower jaw, and on the 12th, there was decided trismus. Complete tetanus followed, which was treated by bleeding, laudanum, the warm bath, mercurial frictions, &c. and, on the 16th day, he was a good deal relieved. This was the 29th of July, but on the 30th, a change for the worse took place; the jaws were permanently locked-the muscles of the abdomen, arms, and neck, rigidly contracted-deglutiton almost impossible-great anxiety, pain in the loins, and insomnium. Convulsions, and loss of consciousness came on, and, on the 3d of August, the patient died. The wound during this time, so far from taking on an unhealthy appearance, had gone on rapidly cicatrizing.

Sectio cadaveris. There was some emphysema beneath the skin, and amongst the muscles of the back and neck. The

substance of the brain was a little injected, and a trifling quantity of bloody serum was found in the ventricies. The tunica arachnoides of the cerebellum was quite opaque, and the substance of the cerebellum itself softened throughout, and reduced at its circumference to a semi-fluid bouillie, of a yellowish grey colour. The medulla oblongata was unaffected, but the spinal marrow, in its upper half, presented striæ, and patches of red in its substance. The spinal dura mater, was much reddened on its inner surface, and between it and the bony canal there was discovered a considerable quantity of bloody serum. In the left side of the thorax there was some effu. sion, and the lower lobes of the lung were exceedingly small and filled with dark coloured blood.

We suppose, for we know of nothing

better that can be offered, that the cause of the tetanus in this case, was the violence done to the cord by dragging it out, which produced, at the time, and indeed for a day or two afterwards, very considerable pain. This may have been the cause, or it may not, for the truth is that we know little or nothing of either the etiology, pathology, or treatment

of these terrible convulsions of the ner vous system. The cicatrization of the wound during the progress of the tetanic symptoms is a curious but not very uncommon circumstance, and it proves that these latter are not dependent, as some would have us believe, merely on a kind of error loci.

8. GLASGOW INFIRMARY.

CASES OF EXTENSIVE BURN, TREATED WITH COTTON.*

Case 1. John Cunningham, æt. 25,

* Surgical Report from the Royal Infirmary of Glasgow. By I. H. Plymsoll, Esq.*

* Having accidentally learnt that a severe burn in this metropolis had been very successfully treated, by a method little known in this country, though employed a good deal in America, we have much pleasure in laying before our readers some authentic facts relative to this mode of treatment, from the Royal Infirmary of Glasgow.-Ep.