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M. Vidal has once carried his proposal into effect, in the case of a woman, 35 years of age, in whom the vesical fistula was so large as to admit the introduction of several fingers through the ulcerated opening, into the bladder. After paring the edges of the vulvar orifice of the vagina, he passed three stitches through the internal labia, and tied them over two pieces of bougie, in the usual manner of forming a quilled suture. Next day, the urine was voided by the urethra; and, for nearly a month, not a drop made its escape from the vagina. The catamenia, also, during this period, passed along with the urine from the urethra. Most unfortunately, a difficulty in passing the water having come on, one of his pupils made an attempt to introduce a catheter into this canal, and pressed too strongly against the vaginal cicatrix. The result was, that the adhesion gave way; some blood was discharged at first, and subsequently urine came away by the wound. M. Vidal closes his remarks in these words :-"The difficulty of closing the orifice of the vagina is indeed real; but to say that it is impossible, is nothing but a vague assertion. The objection that I deprive the woman of son plus bel attribut, that I rob her of her sex, and prevent her from ever conceiving afterwards, is one that it is quite needless for me to reply to."

III. Lithotomy en plusieurs temps.'

In my opinion, says our author, the infiltration of the urine into the surrounding tissues, is the most formidable accident that is liable to occur after this operation. After a wound of the bladder, the urine comes immediately in contact with a loose, and therefore very infiltrable, cellular tissue. Now, if nature does not re-act with energy, and if there be not promptly formed a sort of protecting eschar upon the surface of the incised parts, the effusion of the urine will take place, and death is then almost inevitable. To prevent this accident, it should be our effort to render this cellular tissue less lax and permeable; and this can only be done, with any prospect of success, before the urine is allowed to escape from the bladder. Eh bien! this most desirable result may be obtained, if the operation be performed at several times; if the skin and subjacent tissues down to the bladder be divided at first; and the section of the bladder be not made until after the organic re-action, which changes the physical and vital conditions of the surrounding parts. The first time or step in the operation, in some cases and in certain subjects, might be effected by means of caustic; but certainly the knife is very generally to be preferred.

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IV. Debridement Multiple' applied to the Operation of Strangulated Hernia. M. Vidal, after having pointed out the advantages of the bilateral and even the quadrilateral incision of the Prostate Gland in some cases of Lithotomy-proceeds to point out the applicability of a similar method of proceeding in the operation for relieving a strangulated bowel. Every one is aware that, in certain cases, where there is an anomalous distribution of the epigastric and obturator arteries, great danger of an alarming hæmorrhage is incurred, if the incision of the ring or aperture be prolonged too far in any one direction. Now this risk may, in a very great measure, be avoided by making a number of nicks or little incisions, in place of a single one, that is more free and extended. It is unnecessary to enter into further details; all that is necessary is to suggest the hint.

(The hint is far from being a novel one; it will be found in most of the standard works on Operative Surgery.)

REMARKS ON AMBULANT OR ERRATIC ERYSIPELAS.

"THE epithet applied to this form of Erysipelatous inflammation designates its characteristic feature. The cutaneous affection propagates itself by irregular impulsions. In one case it attacks a part which it speedily quits, without passing through its successive stages; and in another, the disease exhibits all the phases of its complete evolution in the part that is primarily seized. Not obedient to any regular march, it leaps from one region to another, without implicating the intermediate parts; or it suddenly vanishes from the skin, to fasten itself upon some internal organ. The inflammatory action usually does not penetrate deep; it but skims the cutaneous surface. The danger, therefore, of this form of Erysipelas arises not so much from the extent or severity of the dermal lesions, as from the risk of metastasis of the morbid action to some important viscus, and from the cachectic state of the general health.

Erratic Erysipelas may terminate in various ways. In the majority of cases, it proves fatal. It very rarely terminates by simple resolution and by a direct return to health. A fortunate termination of the disease is usually accompanied or followed by some critical evacuation, as a hæmorrhage from the nose, a profuse perspiration, a copious flow of dark-coloured urine, or by a severe diarrhoea.

Occasionally-but this termination has been but little attended to-the critical effort seems to consist in the development of numerous subcutaneous Abscesses, unpreceded by any inflammatory action in the parts so affected.

This lesion must not be confounded with the suppuration of the subcutaneous cellular tissue, that is not unfrequently the consequence of phlegmonous Erysipelas in the ambulant form of the disease, the inflammation is strictly superficial, and the subjacent cellular substance is not involved in the morbid process.

In the two cases related by M. Tanquerel, erratic Erysipelas had continued for upwards of three weeks, and, being accompanied with Typhoid symptoms, threatened great danger; when, suddenly, a number of small indurated tubercles were perceptible under the skin of the neck and chest-the cutaneous inflammation having left these parts a few days before, and attacked the lower extremities. On the following day, many of these tumours presented a distinct sense of fluctuation. In one case, as many as forty-three of these boils or subcutaneous abscesses formed in the space of three weeks. The size of them varied from that of a small nut to that of a pigeon's egg.

They were developed without any previous heat, pain, or redness in the parts affected; and even their existence was often not recognised, before it was found that purulent matter was already formed in them.

From the moment that the earliest abscess was formed, the Erysipelas ceased to make any further advance beyond the part where it happened then to be; and soon afterwards it ceased altogether.

We need scarcely say that the convalescence from such an attack must always be very tedious. There was no reason to suppose that, in either of the cases which occurred to Dr. T., there was any existing Phlebitis,-a lesion which is so often associated with, if it be not the immediate cause of, those metastatic abscesses which are generally referred to what has been called, of late years, a Purulent Infection of the System. It is more than probable that there is always present, in both sets of cases, a morbid alteration of the circulating fluids; although we are not yet prepared to say in what this alteration consists.”—Journal de Medecine de M. Beau, Sept. 1844.

PROFESSOR TOMMASINI ON CHRONIC ARTERITIS AS A Cause of
MANY DISEASES.

THE intimate connection between Rheumatism and an inflamed condition of the heart and arterial blood-vessels has been recognised by many of the most eminent pathologists of the present day. Rasori, indeed, has denied that the arteries are susceptible of inflammation; but in this opinion he is unquestionably wrong. "Since the year 1806," (we quote the words of the proto-physician of Parma,) "my attention has been directed to those morbid vibrations which the arteries sometimes exhibit, and which often occur without being accompanied by any heat or dryness of the surface, redness of the face, or any other symptom of fever. This phenomenon is announced by a monotonous frequency of the pulse, continuing for months, and, it may be, for years; the patient perhaps all this while presenting no symptom of organic disease in any part of the body; and even dissection (for I have seen a good many die in this condition) not disclosing any satisfactory alterations of structure, to account for it."

These arterial vibrations are of frequent occurrence in Chlorotic females, in whom the catamenia have been for some time irregular, and in patients who have lost much blood, either by spontaneous hæmorrhage or by artificial depletion. They are occasionally observed also in the large arteries of an amputated stump, after all the fever and suppurative inflammation have ceased. In women too who have been recently confined, and in children subject to Epistaxis, the pulse is generally found to be more or less vibratory and rapid: the same occurs after frights and great mental disquietudes, in cases of Dropsy of the Pericardium also, and in Hysterical and Hypochondriacal affections. In the last-named maladies, the patients are often affected with such violent vibratory pulsations in the Epigastric region, that they fancy that they must be labouring under aneurism of the abdominal aorta.

"The question now comes to be," says the Professor, "what is the cause of the phenomena alluded to? In no work of medicine, ancient or modern, is there, to my knowledge, any satisfactory explanation of it proposed.

"In my opinion, it is attributable to a chronic phlogistic condition of the vascular system: the experience and observation of many years have tended to confirm more and more my belief in this doctrine. The inflammatory action supposed to be present, is-be it remembered-not only chronic in its nature, but in the minimum degree of force: it may therefore continue for a great length of time, without inducing almost any disturbance of the general health. But if it be aggravated by injudicious treatment, organic changes of the affected tissue may be gradually brought on."

"I have remarked," continues he, " in all diseases termed leucophlegmatic by the older physicians, and especially in Chlorosis, in which there is so marked a tendency to dematous tumefaction of the cellular tissue, that there is a slow chronic arteritis, which in my opinion is to be regarded as the cause of all the phenomena of the malady. The vibratory character and great frequency of the pulse are symptoms well known to every medical practitioner. There is the most intimate alliance between the leucophlegmatic colour of the skin and the swelling of the cellular tissue, and this phlogistic condition of the arterial system; although, on first consideration, we might anticipate a very different result, and expect that, as the circulation of the blood is so very rapid, the lymph, instead of being effused into the cellular substance, would be carried along in the sanguiferous vessels."

Several cases are related with the view of confirming these pathological views. We shall give brief abstracts of two of them, before we offer any criticisms.

Case. A man who had been long addicted to the use of stimulating liquors, was seized with dizziness and other symptoms that indicated plethora in the head. He was freely bled, and kept on a low diet. A month or two afterwards, his appearance was very seriously altered; he was then pale and had a chlorotic aspect; the skin was puffy and seemed to be bloated; he complained of a distressing sense of heat in the chest; his pulse, which was formerly soft and slow, was now exceedingly rapid, and had a sort of metallic vibratory movement; but there were no palpitations of the heart present, nor any decided difficulty of breathing; except indeed upon any bodily exertion or mental disquietude; and then the heart throbbed violently, the breathing was hurried and distressed, and the vibratory character of the pulse was unusually strong. I advised him to be bled, to take pills of aloes and squills, and a chalybeated cream of tartar: the patient, however, refused to be bled, as he attributed all his present suffering to the large losses of blood which had been practised on a former occasion. Subsequently he died of Hydrothorax. "I feel convinced (says Tommasini) that, if the body had been examined, the chief morbid appearances would have been an inflammatory state of the arterial system, indicated by redness and congestion of the inner surface of the blood-vessels, thickening of their parietes, and transudations here and there of concrescible lymph."

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Case 2.-A young nobleman had for some time been subject to attacks of violent hæmoptysis, but without ever exhibiting any of the characteristic symptoms of Phthisis. He had no cough (except when these attacks occurred), nor fever; and yet his pulse was more vibratory, metallic and thrilling than I had ever felt before it was also very rapid. Blood, drawn from the arm, was so highly fibrinous that it became covered with a thick buffy coat, in an unusually short space of time. Besides these well-marked symptoms of Arteritis, this patient exhibited all the appearance of a genuine Chlorosis. He died during a severe access of pulmonary hæmorrhage.

The Professor admits that most medical men would have attributed the vibratory character of the pulse and the other symptoms in the preceding cases to the weakness and a tonic irritability of the vascular system, induced by the losses of blood; but he argues against this opinion on the following general grounds: How comes it, for example, that a young girl, previously in good health, should, in consequence of the stoppage of the catamenial discharge, become affected with Chlorosis? Surely the mere arrest of this sanguineous evacuation ought not to induce the characteristic features of this disease. Again, do we not observe that a patient, affected with any acute inflammation, may lose ten times the quantity of blood-in the same, or even a shorter, space of time-that another patient loses spontaneously, i. e. by some hæmorrhagic disease and yet the former is not found to exhibit the chlorotic appearance and the vibratory condition of the circulation, which are so often observed to exist in the latter. "I do not mean to deny," says Tommasini, "that these phenomena may be induced by excessive sanguineous depletions; but what I insist upon is, that often, in hæmorrhagic patients, we confound the effects of the loss of blood with the pre-existing and essential condition of the malady; and that, in very many cases, the leuco-phlegmatic habit is intimately connected with a morbid condition of the blood-vessels; in short, with a chronic inflammatory state of these parts."

The altered state of the blood is attributed by our author, in part, to the morbid state of the vessels themselves, and in part also to the disturbance of the digestive function; and the tendency to the serous effusions is made to depend upon the intimate alliance between the blood-vessels and the lymphatics, so that whenever one system becomes disordered, the other invariably suffers.

Professor Tommasini then adduces a multitude of cases of Hypochondriasis and Hysteria, in which-alike from the symptoms during life, and (in certain cases) from the morbid appearances found in the aorta on dissection-he contends that there was a chronic inflammation of the arteries present.

"For the last thirty years," says he, "I have taught in my lectures that chronic Angeioitis is the principal cause of flatulences, nervous disturbances, and hypochondriacal affections, or, at least, that it is most intimately connected with these morbid states; and certain it is, that I have often diagnosticated the presence of the lesion in question, in cases where it was never suspected by the other medical attendants, and have afterwards positively ascertained its existence by dissection, to the surprise of those who followed my clinical practice at the time. In most of these cases, the abdominal aorta pulsated with a strong metallic vibration, the complexion of the patient was unhealthy and pale, and the digestive functions were more or less disordered.

*

In spite of the symptoms of gastritis, dyspepsia, flatulence, gastralgia, hypochondriasis and hysteria that were present, I have often detected the cause and source of all the existent mischief, by merely laying my hand upon the epigastric region."

He subsequently qualifies these statements very materially, by admitting that all the phenomena of these diseases may be present, without any real or idiopathic affection of the arterial system; but nevertheless he re-asserts with earnestness his opinion that Angeioitis is of much more frequent occurrence than is generally admitted by pathologists.

The numerous and intimate connections between the nerves that supply the heart and the large intestines on the one hand, and the abdominal viscera on the other, are sufficient, he thinks, to account for the close sympathies that exist between the functions of the Circulatory and Digestive organs, in various diseases, as well as in a state of health.-Annales de Therapeutique et de Toxicologie.

Remarks. The pathological doctrines here propounded are, on the whole, so utterly at variance with those almost universally held in this country, in respect to the diseases alluded to, that it is scarcely necessary to do more than simply direct our readers' attention to the subject. That Chlorosis and hæmorrhagic diseases, when accompanied with a vibratory pulsation of the heart and great arteries, and a tendency to subcutaneous cedema, are generally to be regarded as the effects of a slow chronic Angeioitis, is a position that few English physicians will admit. The practice of Professor Tommasini is a little better than his theory. Occasional bleedings, and the use of digitalis, squills, colchicum, nitrate and acetate of potash, aloes, and steel (for this also is considered to be a contrastimulant), are the chief remedies which he recommends. With respect to this alleged action of steel, it may be worthy of notice that we have frequently had occasion to remark, that the opinions of Italian physicians, as to the action or modus operandi of certain medicines on the system, are quite antipodal to those held by the medical men of other countries. In one of the Numbers of the Gazetta Medica di Milano, during the last year, we find a Dr. Mattii publishing several cases of Pneumonia and other actively inflammatory diseases, in which he exhibited the secale cornutum with (he says) decided advantage: its action, according to him, being hyposthenic, and not stimulant, as is generally imagined. (Rev.)

MESMERISM.

We do not know whether to congratulate, or condole with, the talented Heroine of Political Economy on the strange dream that has come over her soul. It appears that Miss Martineau recovered her health and-we were nearly sayinglost her senses! But this is not the case-she has acquired an additional senseCLAIRVOYANCE! Her maid, BETTY, placed her hand on her mistress's ivory forehead, and, presto, a STEAM-TUG that was passing, became metamorphozed into a ship of celestial glory, fringed with gold and silver, and fit to be "a God-head's dwelling."

It's all in my eye, BETTY MARTIN—EAU !

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