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every other method of treatment, and of the beneficial consequences which would result from its more extensive application, has strenuously recommended this practice to his professional brethren, and has been indefatigable in demonstrating the beneficial results of its operation-exhibiting a strong determination that the practice should become more generally established. Cotton cannot be considered to have any specific influence on burns; any other substance, of a similar nature and consistence, would have the same effect. It constitutes, from its peculiar softness of texture, and unirritating qualities, a soothing and comfortable application, which absorbs the discharge from the wound, and forms with it a case, substituting the place of the original cutis, and affords a thorough protection from the approach of the external air, which would exert a very deleterious effect, if allowed to come in contact with the inflamed or raw surface occasioned by the burn. It is a non-conductor of heat, and, consequently, diminishes that excessive expenditure of heat, which would otherwise be evolved from the injured surface, and which is productive of such injurious consequences. It has the power of accommodating itself more than the ordinary applications, to those irregularities of surface which are generally occasioned by extensively-deep burns, and, consequently, of being brought into more close approximation with the injured parts. Bandages can be applied with almost any degree of pressure, without producing irritation; an equability of pressure is, therefore, kept up on the whole extent of the injury, which has the effect of level`ling irregularities, and of repressing the growth of exuberant granulations, and, ultimately, of effecting a regular and uncontracted surface. The skin which is formed under this treatment is not a smooth, continued skin, as in other cases, but possesses almost the same degree of mobility and elasticity, and those insensible indentations, which are observed in the original skin. This method of treatment, therefore, is particularly advanta geous in burns where the joints are involved, and also in burns of the face, and other parts which are exposed to view, as a cure is effected without restraining the motions of the joint, and without exhibiting the slightest deformity of the face -this is well exemplified in the case

of Cunningham. The granulations will sometimes become prominent, in consequence of a sufficient degree of pressure not having been kept up. In order to obviate this inconvenience, patent lint, covered with sheet lead, may sometimes be substituted with advantage. Should this produce much irritation however, cotton, moistened either with a solution of the sulphate of copper, or chloride of lime, should be again applied, and with increased pressure: this will have the same effect, without being productive of any uneasiness to the patient. The great point, however, in this practice, is the continuation of the dressings, without which, all our efforts will prove inefficient. They should never be removed until it is absolutely necessary, either from the excessive discharge from the wound soiling the cotton, or the insupportable fetor which may arise from it: this last inconvenience, however, may be corrected by the chloride of lime. Many surgeons have attempted this practice, but, ignorant of the necessity of continuing the dressings for several days, have been quite unsuccessful. The reason of this is obvious:-The cotton adheres with such tenacity to the raw surface of the wound, that, in removing the dressings daily, it cannot be accomplished without producing a considerable degree of irritation, and disturbance of the restorative process. It is of importance to observe that, when a part of the dressings are soiled, it can be taken away without removing the whole of the dressings. In the cases which have been treated in this infirmary, the dressings have been removed about once in six or eight days on an average. Every one of the above-mentioned individuals experienced immediate relief from the application of the cotton, and progressively recovered, without exhibiting the slightest constitutional irritation.

I have no doubt that this treatment prevents, in a great measure, those determinations to the viscera, which are so frequently consequent on extensive burns. Cotton has not been applied exclusively to burns, it has been rendered subservient to the cure of abrasions, and superficial iujuries of every description, and will, no doubt, ultimately become a general ap plication.

9. ST. GEORGE'S HOSPITAL.

MR. BRODIE'S CASE OF POPLITEAL
ANEURISM.

In the month of August, the Lancet gave 66 an account" of a case of popliteal aneurism at that time under Mr. Brodie's care in St. George's Hospital, in which "account," as usual, there were errors in abundance. In No. 7 of the Gazette the authentic version of the case was published, and the blunders and misstatements of the Lancet exposed. In our second fasciculus we gave an abstract of the case, and copied almost verbatim from the Gazette the contradictions of the said misstatements. To this exposé, the "INVALUABLE" of last week has made a reply, and that in such a ludicrously intemperate style, that it irresistibly reminds one of a puddle in a storm. It is a circumstance of which our profession should be justly proud that in the improved mode of conducting medical controversies in the present day, we are not trammelled by the obsolete and vulgar rules of truth and justice. Thus, if a man convicts you, in plain English, of a falsehood, all you have to do is to call him a BAT, or a COCK-SPARROW, and that settles the matter. In the present instance, then, the Lancet does not even attempt to defend the truth of its allegations, because it knows, full well, they are indefensible. No, this impartial journal being convicted of mis-statements turns round, and like the ragamuffin in the streets, pelts Mr. Brodie with handfuls of abuse !!

First, it assumes that which it has no right to assume, and which assumption we know to be untrue, viz: that Mr. Brodie is the writer of the Report, merely for the purpose of visiting upon him the sins, such as they are, of the Reporter! It then gives a series of the most quibbling and contemptible criticisms upon the wording of the case which we ever remember to have seen even in the pages of the Lancet. We would not insult the readers of this journal by going seriatim into these paltry verbal criticisms, but we will notice one or two of them. The Lancet is absolutely amazed that the aneurism should increase" by the patient being greatly harrassed in mind and body," and calls it a singular position! Why this learned Theban had better get

him to his book as soon as possible, if he is so ignorant as not to know that exertion will aggravate an aneurism, and that rest is indispensible to its cure. The Lancet takes mortal offence at the words "seem," "numb," and "analogous," and doubt-. less its criticisms are of the highest importance in a pathological point of view, and surprisingly just if one could but understand them-as, however, this is a hope. less matter we shall pass over these abstruse questions and come at once to the practical points."

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On the 6th Sept., fourteen days after the separation of the ligature from the femoral artery, a hæmorrhage of fluid blood burst in a stream from the wound. Firm pressure was steadily made upon the groin, but in spite of it there was a "threatening of bleeding in the night," and, on the morning of the 8th, the presure being still continued, hæmorrhage took place" to a greater extent." The tourniquet was then applied, but, after a time, on loosening it a little, an oozing was observed, and Mr. Brodie (very properly in our opinion) "thought it advisable to tie the artery in the groin," which he did at 2, p. m.

Now, after this statement, which the Lancet has transferred to its own pages, it absolutely makes the following assertions.

"The loss of blood here had been

trifling, and the obvious measure of compression does not appear to have been tried. What, was the two days pressure on the groin nothing? was the application of the tourniquet nothing? was the constant dread, and repeated occurrence of the bleeding from the morning of the 6th till As Mr. 2, P. M., of the 8th nothing? Abernethy says, there is such a thing as common sense. The Lancet makes a sad outcry at Mr. Brodie for having tied the artery, but let us see what it "A graduated comhas itself proposed. press should have been placed over the wound, and the trunk of the artery, from the groin to the wound, should have been covered by another. These should have been covered by a bandage from the toes to the groin."!!! To say nothing of the awful size of these compresses, we shall just look a little at the state of the limb and the wound, which were to have been tortured by all this bandaging. The report states that spongy and indolent granulations had arisen from the wound,

which was little disposed to heal, and that the thigh around was so swollen as to require the application of a poultice. In such a condition a bandage from "the toes to the groin" with compresses," to match" would be admirable, most admirable, practice truly.

There is one other point on which we shall merely touch, as the consideration of it would require more space than we can at present afford, namely, the application of the second ligature just below the giving off of the profunda. It is argued by many, and we believe the argument a sound one, that the tying of a main trunk near the origin of a very considerable branch, is unsafe, inasmuch as the circulation is brought up to within a short distance of the ligature—there is no sufficient clot in consequence, and the danger of secondary hæmorrhage is thereby increased. We say that we believe the argument a sound one, but yet it is disputed, and the fact very far from being unequivocally established. This being the case, we should like to know what right the Lancet has to abuse Mr. Brodie for doing that, which Sir. A. Cooper, Baron Dupuytren, and, we believe, Mr. Cline, have done before him, and which, for ought we know, surgeons may be doing daily. The Lancet arrays against Mr. Brodie, an observation of Mr. Hodgson's, but it has forgotten in its hurry, to notice another fact by the same gentleman, as militating against the necessity for a coagulum!

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into the REVUE MEDICALE, which elucidates this practice.

Case. A young woman of 19 years of age, robust and healthy, received a contused wound on the instep of the left foot -for which nothing was done by any surgeon. A month after the accident, and before the wound was healed, she was suddenly seized with trismus, which went on to opisthotonos. The physician who was called in, found the patient in this state, the wound in the foot being in a bad condition, and covered with proud flesh. Thirty-two ounces of blood were abstraced-purgatives were given-and poultices were applied to the wound. The bowels being opened, the method of Stultz was put in force, and, in the course of twelve days, she took 224 grains of opium, in alternate doses with carbonate of potash, the quantity of the latter not being mentioned. Under the influence of this treatment, the spasms became less severe and less frequent, till a general swelling of the body came on, when they ceased altogether. This swelling appeared to be of an anasarcous nature, and gave way to diuretics, It was succeeded by an eruption on the skin resembling scarlatina. This last disappeared, and the patient got quite well.

The rationale of this practice, we believe, has been attempted on the supposition that, the alkali enables the opium to get at the nervous surface of the stomach much more readily than it otherwise would do and that, in short, it is the preparation which gives the latter remedy the complete power of acting. As opium is still the medicine on which reliance is chiefly placed in this terrible disease, and as their appears no counter-indication to the alkali, we think the method should be tried.

2. PATHOLOGICAL INVESTIGATIONS IN THE DISSECTING-ROOM.

Not unfrequently bodies are brought into the dissecting-room presenting pathological appearances worthy to be recorded, although, unfortunately, we thus become acquainted only with the phenomena in the dead body, not with the symptoms which indicate them in the living. In

the Bibliotheque for November last, M. Cruveilhier has published an account of a dissection, which we shall notice here.

Varices of the Veins of the Round
Ligament.

It is well known that the veins of the spermatic cord in the male, are subject to a varicose enlargement, and that this affection has been occasionally mistaken for an inguinal hernia. We remember, a month or two ago, seeing a case at one of our hospitals, where a young man in a drunken fray got a blow on, or sprained his right groin, in which a tumour immediately appeared. Some few hours afterwards he was admitted into the hospital, having all the symptoms of strangulated inguinal hernia, which was treated by the warm bath, bleeding, the taxis, &c. without relief. The operation was fixed for 4 P. M. but in the mean time, cold, by means of the sulphuric æther, was steadily applied. The surgeons and pu pils had collected, and all was prepared for the operation, when a portion of gut suddenly "went up" under a moderate application of the taxis. Considerable swelling, however, still remained, and it eventually turned out, that there had been an inguinal hernia, combined with varicocele and hernia humoralis, the patient having laboured under a clap for some time previously.

The patient, we should say the subject, which came into the hands of M. Cruveilhier, was a female, about 60 years of age, having an oblong tumour at each external ring, which M. C. imagined, to be a brace of herniæ, aud proceeded to operate on one of them accordingly. On cutting through the skin, the external pudic veins were found to be very tortuous, and one large vein in particular was seen to cover the upper pillar of the ring. Continuing the incision, the knife came down to a muscular substance, resembling a hypertrophied bladder, or uterus at the 3d month of pregnancy. M. Cruveilhier thought he had come upon a hernia of the bladder, but n'importe he cut on, divided the "fleshy tissue" into laminæ, and at last opened into a large vessel, which proved to be a vein with its coats much thickened. The operator was now fairly bothered, and determined to satisfy his doubts by cutting into the abdomen, and introducing his finger from that into

the ring. To shorten a long story, it was discovered that the tumour was made up of the "muscular substance" of the round ligament considerably thickened and hypertrophied, and its veins bound together by fibrous bands, and exceedingly varicose. The veins of the legs were very varicosé also.

This good lady must have been a museum in herself, for besides the above rare affection of the round ligament, she presented some curious appearances in the abdomen. The mesentary commenced at the pylorus, so that the duodenum was contained within its laminæ, and not distinguishable in this respect from the small intestine generally. The right half of the pancreas was contained in the mesentery, and the cæcum, ascending, transverse, and descending arch, and sigmoid flexure of the colon, formed but one tortuous arch, not above half its usual length Several other anomilies in the mesentery and epiploon, were observed, but we need not stop to desscribe them. The lower half of the anterior wall of the vagina was affected with cancerous ulcerations, by which it communicated with the bladder. The base of the ulceration was white, brittle, and prominent, several little prominences projecting into the bladder, and one of them being covered by a calculous deposit of uric acid.

Whilst upon the subject of dissectingroom pathology, we may take notice of a paper published by Mr. Cæsar Hawkins, in No. 10 of the Medical Gazette, containing an account of some appearances observed in two bodies brought into the School of Great Windmill-street. The first was a middle-aged man, who had been affected with rickets to an extreme degree. It appeared that, whilst labouring under this disease, the left knee had been dislocated, so that the tibia rested on the fore part of the femur. In this situation, a new joint had been formed, the back part of the head of the tibia being flattened, and a kind of cup, having formed on the front of the femur, above the condyles, which was rendered more complete by the growth of a large knob of bone immediately above it. The surfaces of this new articulation were coated with an imperfect cartilage, and provided with a distinct synovial membrane, and ligaments of considerable strength.

The patelia of that side was much smaller than the other, probably, as Mr. Hawkins observes, from its not having been called into exercise, the new form of joint not allowing of flexion and extension of the leg. The hip joints were remarkably altered also, the neck of the femur being on each side absorbed, so that the trochanter and head of the bone were on a

median nerve. One or two smaller anastomoses were also observable between these nerves nearer the wrist.

level with each other. The head itself 3. EXTRACT OF VALERIAN, IN FULL DOSES. was flattened and widened, as was the acetabulum, which was much shallower than usual. From these circumstances, Mr. Hawkins thinks it is evident that the enarthrotic, or ball and socket articulation was lost, and had degenerated into little more than a mere hinge-joint. The patient had been obliged to use crutches, so that the head of the humerus was forced up against the acromion, and between these parts there was found a number of enlarged bursæ, filled with a quantity of thick gelatinous fluid. Thus, the very pressure and irritation produced their remedy, namely, the interposition of these additional friction-wheels between the ends of bone.

Every practitioner is aware that valerian
exerts a very considerable sedative influ-
ence over the nervous system; but the
extremely disagreeable odour of that root
(to some more offensive than assafœtida)
very much limits its use, especially among
females, where it is most wanted. Dr.
Guibert, of Paris, has recently exhibited
the extract of valerian, in doses varying
from one to two or three drachmas per
diem, in several disorders of the nervous
system-and, if the cases
As
faithful, with considerable success.
the medicine is perfectly safe-as the
root has long been employed with ad-
vantage-as its bulk and flavour are ob-
jectionable-and as the extract appears
to possess all the medicinal properties of
the root, divested of several inconvenien-
ces, we think it a medicine which de-
serves attention, particularly in a number
of female complaints equally distressing
and unmanageable.

detailed be

The cases in which Dr. Guibert has employed the extract are spasmodic contractions of the muscles of the limbsnervous tremors in adults, when unaccompanied by any signs of plethorachorea-epilepsy, in which disease he has found the valerian very serviceable, after sanguineous and other evacuations

In the second case detailed by Mr. H. it appears that the median nerve, flexor digitorum sublimis, and flexor carpi radialis muscles, and the radial artery, had been divided by some wound inflicted a considerable time previous to the patient's death. The portions of the flexor digitorum were united by an imperfect ligamentous substance, and the flexor carpi was partly deficient. The radial artery was likewise deficient for nearly three inches, its lower part being supplied by an enlarged branch of the interosseous. But the more interesting appearances were observed in the median nerve. This terminated, about the middle of the fore-arm, in an oblong tumour-palpitation of the heart, when of a of a light brown colour and firm consist- nervous character, as they very often are ence. The filaments of the nerve were -spasmodic asthma,and nervous dyspnoea separated, and spread out over its up--hooping cough, in its later stages, and per end, whilst at its lower, the tumour had contracted inseparable adhesions to the ligamentous part of the flexor sublimis. The nerve below the annular ligament was perfectly natural, but between this lower portion and the tumour on the upper, there was a separation of at least three inches, without any intervening substance whatever. An enlarged branch, however, was given off from the superficial division of the muscular spiral, which passed through the flexor sublimis and joined the lower portion of the

after the inflammatory symptoms have subsided-dyspepsia and gastrodynia unattended with any obvious inflammatory symptoms--vomitings of a nervous character, and not apparently dependent on any organic disease-and last, not least, the various proteian forms of hysteria. Of all these complaints, the Doctor has adduced examples in our Parisian cotemporary-the REVUE MEDICALE, for December last. These cases we shall not detail; but we think the remedy is worthy of the English practitioner's notice.

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