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24 inches, and averaged a quarter of an inch in depth. Also the subcutaneous structure was completely lost, so that the arteries and veins were seen, as if neatly dissected, lying on the surface of the muscles and fascia." The successful issue of the case reflects great credit upon the author, especially as more than one untoward occurrence intervened. Three principles especially guided him, the due supply of nutritive food, the regulation of the animal heat, and the external and internal use of antiseptic agents, such as the application of yeast, the evolution of oxymuriatic gas into the apartment, the administration of alkalis, &c. During the extensive suppuration which occurred, six pints of milk in the twenty-four hours served to support the youth's (æt. 17) strength. A sphacelated wound over the sacrum, an attack of bronchitis, and an extensive reopening of the wound by erysipelas, successively retarded the cure, and long rendered recovery apparently hopeless. It required several years to produce entire healing, during and subsequently to which there has been much tendency to congestion of the brain, requiring small depletions and aperients, and attributable to the imperfect re-establishment of the functions of the skin over so large a surface.

Insanity. Mr. Grantham has two chapters upon the premonitory symp toms and treatment of insanity. He says:

"The duties of the general practitioner in cases of insanity, are chiefly limited to the treatment of the premonitory symptoms: it is at that time when the patient stands, as it were, on neutral ground, that the practitioner is sent for; at a time when he is surrounded by relatives and friends, and the soothing attentions of home-circumstances often the most favourable for the sufferer. But with these advantages, a very frequent cause of error in the judgment of a medical man (when called upon to decide as to the state and probable restoration of the patient) is the undue regard which is paid by him to the wishes and opinions of the friends who seem to take a pleasure in enlarging upon the odd whims and irregularities of the patient. The fears of one party, and the ignorance of both, soon settle the question, and at once precipitate the poor sufferer from a state of comparative sanity into irremediable madness. A medical man will do well to prefer even the immethodical relations of the patient, rather than trust to the opinions of friends; for how often is it that actions, seemingly the most whimsical, may be strictly consistent with the physical condition of the invalid: thus insane persons, tormented with feverish heat, delight in exposing themselves to cold air or water, while, as M. Esquirol observes, a disordered state of the digestive organs often renders them averse to taking food." 113.

The importance of attention being paid to the early symptoms of insanity cannot be over-stated; but we must join issue with the author as regards the steps which should be taken upon a discovery of these. So far from having found friends anxious to make out the patient's case as worse than it is, and thus unnecessarily consign him to an asylum, we have too often observed the very contrary, an unwillingness to perceive that which has become obvious, and a delay in resorting to aid which has often proved detrimental to ultimate recovery. Moreover, the separation from home which he seems to regard as a calamity, is the step which is ordinarily essential to giving the patient a fair chance; and Esquirol and Pinel, whom he quotes as stating the greatest number of cures are effected within the first month, certainly are alluding to the case of patients so circumstanced.

To treat an hypochondriacal or hysterical patient (and many of the author's observations in this chapter are applicable to such) as insane, would indeed be likely to aggravate their maladies; but when the diagnosis of insanity has been satisfactorily made out, seclusion cannot be accomplished too

soon.

Effects of Deficient Ossification of the Cranium.-The following is part of a passage quoted from a paper upon the employment of compression in certain cases of hydrocephalus, which was contributed by Sir Gilbert Blane to the Med. and Phys. Journal for Oct. 1821:

"It occurred to me that the distention of the head and bregma is owing to a want of firmness and due resistance in the bony compages of the skull, which consequently yields to that effort of pressure with which the brain, in its growth, acts upon its parietes. In reasoning farther on the subject, it appeared to me conformable to some of the most approved principles of physiology, that, as there is a certain degree of tension and pressure necessary to the sound condition and action of parts, the withdrawing of this, by inviting afflux and congestion, produces serous effusion; and, for the like reason, there may be a deficiency of that interstitial absorption upon which the healthy state of this and of all other parts of the living frame depends."

The author adopts these views as explanatory of certain cases of epilepsy, cerebral congestion, and hydrocephalus ; such imperfection of structure resulting from " improper nutriment, a strumous diathesis, and a lack of warmth of the skin during the first seven or eight months of infantile life." The cases of four infants are related, two affected with epileptic fits, one with "restlessness and general indisposition," and the other with "oppressed breathing and emaciation," in which the supporting the cranial bones by bandages seemed to be productive of benefit. From their small number, and the employment of other means of treatment likewise, they go for little.

Galvanism.—We quite agree with Mr. Grantham, that the application of galvanism in paralysis, and other chronic affections of the nervous system, has been too much neglected. Indeed, its administration seems to be confined almost to empirics, who apply it in all cases indiscriminately, and consequently do more harm than good. Why a full and fair trial of its medicinal powers should not be made in some of the numerous chronic cases which encumber the hospitals, we cannot imagine. Mr. Grantham relates some cases in which he found this agent, carefully administered for a prolonged period, completely successful; and states the results of his experience in its employment in these conclusions.

"1. Galvanism is identical with the vital action of the nerves of organic life, and the nerves of volition. 2. Its action is determined by the healthy condition of the brain and spinal marrow. 3. The skin must possess a normal sensation, as well as temperature, before the galvanic action can affect the muscular fibre. 4. The positive plate or wire should be applied over the region of the origin, and the negative to the region of the termination of the nerve. 5. The galvanic influence, when passed along the spine, will be most active in the paralyzed limb. 6. Galvanism is assisted by the alkalis and mercurial action. 7. It restores diminished temperature, decreased circulation, and lost muscular action, in the following order: 1, temperature, 2d, circulation, and muscular action last. No. 99.

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8. It has no effect in disease that alters the structure of nerves. 9. It supersedes manual friction. 10. It is assisted by immersion of the affected limb in a warm bath, into which, the negative plate or wire is placed. In passing a current from the head through one half of the body, the foot should be immersed in warm water. 11. It is injurious when much pain is caused in the muscles by its application. 12. It may be carried to an undue extent, so as to produce congestion of the brain." 183.

Secale Cornutum.-Of this medicine the author thus speaks:

"I have seen the uterus impaired, as to its future contractile power, after the use of large doses of ergot of rye, and have frequently had occasion, during the last two years, to apply the forceps to assist the parturient efforts of those persons in whom the practitioner had previously hastened the labour with the above drug. On the other hand, if the cases be properly selected, it forms a most useful auxiliary in effecting the expulsion of the foetus. The ethereal tincture I have found very valuable in suppressing uterine hæmorrhage, and I am in the habit of giving one drachm, in a wine-glass of warm water, to mitigate the after-pain. It relieves the patient better than opium, and without producing any ill effect upon the sensorium. If too much discharge come on after delivery, I increase the dose to two drachms, and repeat it according to necessity." 195.

Premature Vaccination.—Mr. Grantham believes, from the greater in. susceptibility of the infant constitution, this operation is best delayed until after the termination of the period of lactation, i. e. about the ninth month. He has come to this conclusion from observing that children vaccinated earlier are more liable afterwards to contract small-pox than those vaccinated at a later period. He quotes some observations, by Mr. Deane and Dr. Murray, of Cape Town, as confirmatory of the superior protective

power of late vaccination. The last-mentioned experienced practitioner recommends the operation being delayed only to the 5th or 6th month. If a greater durability of the protective power really does result, the immediate consequences of delay need not excite much alarm; for young infants, however much exposed to infectious diseases, seldom contract them, and are sometimes the only members of the family who escape. When small-pox rages epidemically, however, no delay should be allowed, and we have seen very young infants infected, (and they usually die when they do contract the disease,) during the epidemic of this last summer and autumn.

Fibrinons Diarrhea.-The Diarrhea Tubularis of Good. This is a rare and often an obstinately chronic disease. In all the cases which the author has seen, its production has been preceded by the exhibition of mercury, with the too active employment of aperients.

"In the cases that have come under my notice, the discharges from the intestines have assumed, in the first stages of this complaint, a mucous appearance; secondly, a mixed muco-fibrinous character; and lastly, the evacuations have contained true fibrin. The evacuations of fibrin have been preceded by longcontinued pain in the abdomen, and great irregularity in the temperature of the skin; the individual being highly sensitive to a damp atmosphere, which caused spasmodic pains in the abdomen. When the mucous membrane of the fauces and posterior nares is implicated in the disease, the patient suffers much from violent pain in the head, referrible to the region of the parietal bones, with ex

treme irritability of mind. There is a great tendency to acidity in the stomach, which is increased under the use of a liquid diet. The abdominal pains are always of a spasmodic character, and at times very acute, extending to the neck of the bladder, and down the inner part of the thigh. The tongue assumes a white appearance, with indentations round the edges; sometimes ulcerations of a phagadænic kind forms over the tonsils. The pulse is seldom altered, generally maintaining a steady, healthy, feel; the skin is often studded with numerous papulæ, especially over the chest, neck, and face. The urine denotes an anæmiccondition of the kidneys: occasionally such patients pass urine with evident traces of albumen, seldom containing a normal quantity of the phosphates. On an increase of fever or mental excitement, a larger quantity of the lithate of ammonia is found; frequently the mucous membrane of the bladder is thickened in these cases. The fæces, which are very seldom incorporated with the fibrin, are often very healthy in appearance, clearly showing a natural action of the glandular system. Although it is said by most authors that this disease is by no means fatal, yet I think I have seen it degenerate into atrophy of the intestines." 205.

Mr. Erasmus Wilson, writing to the author, after alluding to two cases which he had noted, and which occurred independently of the administra tion of mercury, observes

"I do not agree with Dr. Golding Bird in thinking the principal seat of the inflammation in this disease to be the mucous follicles, nor does the false membrane appear to me to be simply an altered mucous secretion. The mucous follicles may, and very probably do, constantly participate in the inflammation of the mucous membrane: there is nothing anti-physiological, moreover, in supposing that they may be inflamed separately from the mucous membrane. But the character and appearance of the membranes that I have examined, their breadth and continuity, have led me to believe that they are a product of the superficial mucous surface. Animal chemistry can avail us little in determining the nature of a deposit of this kind. Protein, albumen, gelatin, fibrin, mucus-all are composed of the same elementary constituents, varying so slightly in proportion, that it is clear that they are all modifications of the same staminal principle. In croup, we do not hesitate to ascribe the production of the false membrane to the superficial mucous membrane; indeed, we have seeming proof that this is the case in the smaller relative proportion of the infected membrane; I am therefore desirous of claiming as much for the pulmonary mucous membrane in another place-namely, in the alimentary canal.

"Against my hypothesis of the analogy between croup and fibrinous diarrhea, you might be inclined to urge the acute inflammation of the former, and the chronic character of the latter. But the latter is chronic only in duration. Its seat is limited and dispersed, and the patches which produce the lymph are each, as I imagine, as acutely inflamed as the pulmonary mucous membrane in croup." 215.

In the treatment of the disease, Mr. Grantham recommends residence in a dry locality, warm clothing, friction and ablutions, regular exercise, with a mild, moderate, unstimulating diet. Purgatives must not be resorted to but as an occasional means of removing painful accumulations of fibrin; when castor oil is the best. A tepid enema, with or without narcotics, to be used every morning. Alkalis may be given according to the condition of the gastric secretions and the urine. In obstinate cases, injections of nitrate of silver are useful; but stimulants, such as copaiba, turpentine, &c. are useless. In one bad case, cod's liver oil improved the condition of the patient without curing the disease.

"In conclusion, the treatment should be of a negative character, by which I mean, avoiding everything that may interfere with the natural law of the part affected; or, in other words, let the organism of the intestines effect its own restoration. It is better to keep that principle in view during the treatment; yet, on the other hand, all irritants must be removed, and acute pain must be subdued. In the early stages of the complaint, when the evacuations are of a mucous or muco-fibrinous character, the hydriodate of potash with morphine, may be given with advantage, the former in ten-grain doses night and morning, with half a grain of the latter at bedtime."

208.

A PRACTICAL ENQUIRY INTO THE VALUE OF MEDICINAL NAPHTHA IN TUBERCULAR PHTHISIS. By Ed. Oct. Hocken, M.D. Physician to the Blenheim-street Infirmary, &c. &c. &c. 72 Highley, London, Nov. 1844.

8vo. pp.

WHENEVER We hear of a remedy for tubercles in the lungs, we feel a scepticism rising in our minds. When recovery takes place, what proof have we that tubercles existed-or that they were removed by any specific medicine? Scarcely a day passes that we do not see and hear young doctors diagnosticate the existence of tubercles in the lungs-often, according to their own account, when they are not larger than pins' heads! In such cases, it is not unlikely that naphtha, or pure air, or prussic acid-or TIME will effect a cure of "tubercular phthisis." In the early stages of pulmonary tubercles we believe that they cannot be detected, and therefore the vaunted cures are more than doubtful-in the confirmed and obvious cases, the result is not at all doubtful-being DEATH in 99 instances out of 100! Dr. Hocken truly informs us that auscultation and percussion require a natural delicacy in hearing and appreciating sounds," as well as a "taught and thoroughly-practised ear" to interpret those sounds. In the succeeding page, he tells us that "he believes his sense of hearing to be naturally excellent, as he has found himself capable of distinguishing and appreciating sounds which were not detected by some others engaged in the same pursuits." In addition to all this, he informs us that, "during the last ten years, he has possessed very ample opportunities of gaining proficiency as an auscultator"-and that, during this time, "he has studied under some of the best auscultators in the world." We would hint to the ingenious author, that it would have exhibited more "natural delicacy," on his part, if he had employed some friend, or one of his master auscultators, to pen the foregoing particulars.

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Dr. Hocken commences his preface with the following declaration :"The author has put forth the following essay, with a sincere desire to benefit others, and entirely without the probability of benefiting self." This has been the declaration of almost every author who has ushered an infallible remedy for an incurable disease into the world. For what purpose does Dr. Ramadge render "consumption curable," but for the benefit of others?

Our author was stimulated to the investigation in question by "the fact

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