G. Scales without redness.
Icthyosis.

H. Papule without redness.
Lichen chronica.

Prurigo.

1. Vegetable productions.
K. Animal productions.

A. In eczema, the serous secretion oozes from a red surface, by myriads of little canals or openings, in the form of minute drops, or fine moisture.

In acute pityriasis the serous oozing is a sort of sweat, but without any perceptible punctuated state of the skin.

In eczema lichenoides, the serosity proceeds from a rounded patch, which is sprinkled over with a multitude of papula that render the surface somewhat rough. The discharge is exhaled between the papulæ.

In scabies, the serosity is contained in minute isolated Vesicles; whereas, In herpes phlyctenoides, it is within Bullæ, that are either distinct and separate, or are situated so near to each other as almost to touch. In pemphigus, the bulle are still larger.

B. There is one disease only, viz. eczema impetiginodes, in which the secretion is partly serous and partly purulent at the same time. The product of this secretion is a crust of a yellowish-gray colour.

c. In rupia and ecthyma cachecticum the secreted matter is partly purulent and partly sanious. In the former, the crust, that is subsequently formed, has an illfavoured appearance-being formed of pus, ichor, and blood-and is always more or less irregular in its form. In the latter, the crust exhibits the same characters, but it rests upon an inflamed base, and retains the rounded shape of the pustule which preceded it.

D. Among the cutaneous diseases in which the secretion consists entirely of pus, impetigo is alike the most common and most important: its crusts are always purulent, superficial, and of a gold-yellow colour, not unlike that of concrete honey.

In acne, the pustules are hard at the base, and elevated; in purulent scabies, they are flat and more uniform. In ecthyma, the pustules are flat and of a large size, and exhibit in the middle a dark point, which gradually becomes more and more depressed, so that at length they are umbilicated, as in small-pox.

We must pass over the remaining family of this section, and all those of the other or non-secreting class, till we come to the last two groupes of the seriesviz. the Vegetable and Animal Productions of the skin. Among the former, are enumerated the three varieties of genuine tinea or favus, viz. f. scutulata, lupinosa, and granulata; also the porrigo decalvans, and herpes tonsurans. Much skill and experience are required to discriminate these affections.

The animal productions comprise the pedicular disease, and that which engenders the pulex or flea.

M. Devergie promises to show, in a subsequent article, the practical bearings, in a therapeutic as well as in a diagnostic point of view, of the classification which he has proposed :-the treatment required for secreting diseases of the skin being very different from that which is suited to those that are non-secreting.-Bulletin General de Therapeutique.

THE PLAGUE IN EGYPT; ITS CAUSES.

FROM a memoir on this subject, recently read before the Academy of Medicine

by M. Hamont, we select the following picture of the loathsome condition in which a large portion of the population of Egypt is living, even in the present day. I have passed," says he, "fourteen years in that country, and I have studied the disease with all possible care. It is truly endemic there; no one disputes the fact; and the cause of its being so, it is not difficult to explain. The plague reigns exclusively in what is called Lower Egypt-a region where every imaginable condition of insalubrity is found combined; and that too in a degree which it is not easy for any one to credit, if he has not himself been an eye-witness. The dwellings of the fellah population are constructed of mud, and are usually situated beside some stagnant and putrid water. They are common alike to men and beasts; and when night comes, all the inmates lie down together on some filthy straw, with nothing but still filthier mats to separate them. The very ordure on the floor is removed only for the purpose of hanging it up in lumps from the walls to dry: this serves for fuel! Judge of the stench that must arise from this novel species of combustible matter. Then again the horrid miasms from putrid carcases of different animals lying round the walls, and perhaps also from the bodies of human beings buried only a few inches underneath the surface. Who, but a fellah, could endure such horribly offensive scenes ?

"When, in consequence of the excessive mortality from the Plague, the living are insufficient to inter the dead, the bodies are carried away in heaps upon a bier to the cemeteries, and there left to rot in the open air. The villages, that are in short nothing better than a heap of privies, are usually surrounded with a belt of rubbish, as if actually to prevent all chance of ventilation! Often the traveller knows that he is approaching some dwellings, only by the very exhalations that corrupt the air around. And yet the poor ignorant inhabitants will refuse all advice or the suggestion of any change; nay, they treat as impious whosoever ventures to propose it, telling you that, do what you may, death will come at his appointed time!

*

"Three-fourths of the population live on tainted meat-the flesh perhaps of animals that have died of carbuncle-on old rotten cheese, putrid fish, leaves of radishes and other vegetables; and in some districts on rats and locusts. Such is the common food of this wretched people-the slaves of a most cruel despotism.-Comptes Rendus.

THE THERAPEUTICS OF NATURE.

"THERAPEUTICS, it is very generally admitted, is one of those branches of medical knowledge in which there exists the greatest amount of errors, defects, and prejudices; and where experience is alike most difficult and deceptive. The mistakes, that are daily made, are often far greater than we are willing to admit. And then, how little do we know of the extent of Nature's own curative resources, and how much she will often effect, unaided by, or perhaps even in spite of, the interference of art. In the practice of our profession, it should ever be borne in mind that we have to do, not only with the existing disease, but also with the conservative and reparatory efforts of Nature,-which, by itself, is often sufficient to produce a cure. Hence those reputations of medicines and modes of treatment, which so rapidly start up and are as quickly forgotten; and hence those false gods of Therapeutics, that to-day are adored, and to-morrow are despised.”— Bulletin de Therapeutique.

ON THE OCCASIONAL PULSATION OF THE VEINS.

Ir is not to that pulsation of the jugular veins-which depends upon a reflux of part of the blood from the right cavities of the heart, in consequence of the imperfect closure of the tricuspid valve-that the following remarks are applicable. "Our present object," says M. Martin Solon in his communication to the Royal Academy, "is to draw attention to a pulsatory movement that we have occasionally observed in the veins on the back of the hand-a movement, that is dependent upon an isochronous continuation of the arterial pulse, and which, therefore, truly deserves to be considered as a pulse of the veins." The first instance, in which he observed the phenomenon, was one of severe Pneumonia, after the patient had been largely bled. On the fifth day, the dorsal veins of each hand were perceived alternately to swell up and to subside, as is the case with any superficial artery. The pulsations were distinctly isochronous with those at the wrist. It was abundantly obvious that the movements of the veins were quite independent of those of the neighbouring arteries, and of the agitation of the subjacent tendons. When the Brachial artery was firmly compressed, the pulse in the veins, as well as in the radial and ulnar arteries, was at once suspended. In this instance, the phenomenon in question was observed for six or seven days successively. M. Solon expressed his conviction, that the venous pulse was in short nothing else but the continuation of the ordinary arterial one, communicated from the arteries directly to the veins. It is not improbable, he very justly remarks, that, in order that this phenomenon may occur, the circulating fluids should be in a more attenuated condition than they are in a state of perfect health. That such is probably the case, is rendered still more likely by the results of the second case one of Typhoid fever-related by him.

Dr. Graves also has had occasion to observe a distinct pulsation of the veins in two cases of active inflammation, in both of which blood-letting had been already freely employed; and Dr. Ward too has seen it in a woman recently delivered. It would seem therefore that the phenomenon in question is decidedly connected with an attenuated state of the blood.

M. Cruveilhier stated that he had never seen any appearance of pulse in the veins of the hand, although the phenomenon in question was not at all uncommon in the veins at the bend of the arm. He had indeed more than once, in consequence of the vein in blood-letting throwing out its contents in jets, been apprehensive that the artery was wounded; but such an accident had never occurred in his practice. He attributed the phenomenon of the venous pulse, in all cases, to subjacent arteries communicating their movement to the veins; and never to any direct transmission of their pulsations along their capillary extremities.

M. Velpeau alluded to a case of Typhus fever, in which all the superficial veins in both upper extremities were moved with most distinct pulsations, that were certainly not owing to any shock communicated to them directly by subjacent or neighbouring arteries. On the whole, he was inclined to attribute the phenomenon to the reflux of the blood backwards from the heart, along the subclavian and brachial veins. But, as M. Solon remarked, how could this explanation hold in his two cases, where there was no pulsation of the brachial and anti-brachial veins, but only of those of the hands?

M. Blandin expressed his entire concurrence in the opinions of M. Solon. He alluded to the circumstance that, two centuries ago, Harvey himself had distinctly asserted that the heart will sometimes transmit its pulsations even to the veins: and he then mentioned some experiments which M. Magendie and he had performed, and which tended to establish the truth of this position. If a part of the circulatory system be emptied, (in the dead body,) by means of a first injection pushed in with force, and then a second injection be thrown in, by jerks, into a large arterial trunk, we shall find that it will escape from a wound in any

one of the principal veins of that system, in jets, as from an artery. If this can be done in the dead body, why should we deny the possible occurrence of it in the living?

M. Dubois intimated his dissent from these views, and agreed with M. Cruveilhier in ascribing all venous pulsations, either to the shocks communicated from the contiguous arteries, or (in some cases) to the reflux of the blood along the jugulars.-Comptes Rendus.

ON THE USE OF THE THYMUS GLAND.

DR. Picci, after glancing at the theories of his predecessors, suggests that the use of this Gland is chiefly of a mechanical nature; viz. to occupy a certain space within the thoracic cavity, while the lungs remain unexpanded in the fœtus; and thus to prevent the ribs and sternum from falling in too much upon these vital organs. The size of the Thymus is inversely as the volume of the lungs; and, when the latter become dilated after birth by the admission of air into their cells, the former immediately begins to shrink and become atrophied. In truth, it is only in the adult that the thoracic parietes are moulded completely upon the lungs; for, in infancy and youth, it is rather the Thymus gland that is, in their place, moulded upon the thorax.

The situation of this gland in the anterior mediastinum and along the median line, the very nature of its tissue, and the greater expansion and development of its inferior half, are adduced as arguments in favour of the opinion now adduced. Besides the well-known circumstance that, in those new-born children in whom the thorax is very largely developed, the Thymus continues to increase gradually even to the end of the second year, it deserves notice that all those animals, in which the lungs are similar to those in the human subject, are provided with this gland; whereas, we find it to be entirely wanting in those which breathe by Branchiæ or membranous lungs. In hybernating animals, also, the Thymus exhibits alternations of enlargement and decrease, according to the state of the respiratory organs. In the Amphibia it attains its maximum of development.

The circumstance too of the gland being usually rather larger than ordinary in phthisical patients may be mentioned as lending some probability to the view we have proposed.-Annali Universali.

SPONTANEOUS EXPULSION OF THE OS HYOIDES.

A MIDDLE-AGED woman, of a rachitic constitution, became affected with an enlargement of the glands around the lower jaw, accompanied with a slight cough, and disturbance of the breathing. In spite of treatment, these symptoms went on gradually increasing, for three or four years. The sputa became thick and viscid, and were occasionally streaked with blood; the patient was every now and then distressed with attacks of suffocative dyspnea, and her strength was greatly exhausted by colliquative sweats. The voice was at length completely extinct; and now there was a fixed pain, with an almost continual sense of pricking, in the laryngeal region. The sputa were at this time very decidedly purulent, and were often rejected without any effort of expectoration: it was a simple expuition that followed immediately after a lacerating pain felt in the throat.

The condition of the patient had for a length of time appeared quite hopeless, when most unexpectedly-after experiencing more than usual suffering from the cough, dyspnea and pricking pain in the throat-she expectorated, in the midst of a convulsive agitation of the whole body, a firm hard substance, which proved

to be a bone of considerable size. On being examined, it proved to be the os hyoides. The health of the patient speedily improved, and was ultimately quite restored-five years after the commencement of her first suffering. The bone was examined by several members of the Academy, so that no reasonable doubt as to its nature can be entertained.-Comptes Rendus.

SURGICAL MEMORANDA BY M. VIDAL.

1. Luxation of the First Phalanx of the Thumb.-The reduction of this accident is almost always extremely difficult. A variety of suggestions have accordingly been proposed to effect the object in view. Shortly after I arrived (says our author) in Paris, a case of Dislocation of the Thumb backwards was brought into the Hôtel Dieu : every imaginable attempt to reduce the displacement was ineffectually tried. M. Dupuytren delivered a lecture upon the accident, and endeavoured to prove that the irreducibility was caused by the altered position of the lateral ligaments of the joint: these bands, in consequence (he supposed) of having become stretched in an oblique direction, bound down the digital bone against its metacarpal fellow. Upon that occasion, I showed that the real obstacle was a boutonniere of muscular substance, which strangulated the head of the metacarpal bone, and became the more and more tightened in proportion to the force with which traction was applied to the displaced phalanx. This impediment is formed on the outer side by the external portion, and on the inner side by the internal portion, of the small flexor pollicis and adductor brevis. As the heads of these muscles are inserted into the upper extremity of the first phalanx, they are necessarily forced backwards along with the dislocated bone, and the upper metacarpal protuberance is thus held fast between them. To effect the reduction, tractions in a variety of directions had been (as already mentioned) tried for a length of time; but all in vain. I proposed to cut away the head of the metacarpal bone; but the suggestion was not, and perhaps wisely, adopted. M. Malgaigne has more judiciously suggested that it would be better to divide the external portion of the boutonniere or strangulating muscular band.

II. Vesico-Vaginal Fistula.-M. Vidal has proposed, in unmanageable cases of this most distressing accident, to obliterate the orifice of the vagina entirely, so as to convert this canal into a blind passage, and thereby to prevent the issue of the urine from it. This idea was suggested to him by the accidental effects produced by the nitrate of silver having been applied rather too freely to the anterior and posterior walls of the vagina, in a case where the use of a suture to the fistula had failed, and the application of the caustic had been tried instead: the opposite walls of the vagina joined together, and quite prevented the escape of any fluid from its orifice. The result was, that the urine flowed from the urethra. This state of things continued for nearly a fortnight. Unfortunately, upon endeavouring to ascertain, by means of a manual examination, the state of the parts, the feeble adhesion of the vagina gave way, and the urine again began to escape from its orifice.

In this, and indeed in almost every case of vesico-vaginal fistula, a great obstacle to the cicatrization of its edges is the fact that the bladder has usually become so contracted upon itself, that it is unable to hold any considerable quantity of urine. The fluid is therefore continually escaping from the ulcerated opening; and, when the discharge is obstructed by suture, the patient is distressed with most frequent calls to micturition. The effects thus induced very materially interfere, as a matter of course, with the process of healing: and unfortunately too, the leaving of a catheter in the bladder does not answer well, in consequence of the contracted state of the cavity of this organ.