Our author has sometimes conglomerations of several smaller ones. found these milanoses mixed with encysted tumours, containing a very yellow kind of fat, with mucilaginous and gelatinous sub stances. Another form of these melanose productions is that of false membrane, or membranous expansions on the surfaces of the mucous and other tissues. Sometimes the black matter is extravasated, in the consistence of bouilli, into the cavities of the body. In some cancerous affections of the liver, intestines, and uterus, the serous infitrations are tinctured with this black matter. This matter has been analyzed by Messrs. Barruel and Lassaigne, and these analyses lead to the conclusion that it is a deposition of the colouring matter of the blood, of fibrine, and of three distinct sorts of fatty matter. In many diseases we observe secretions of dark matters, as the black vomit in yellow fever, and black alvine excretions attending cancerous affections of the stomach and bowels. The black incrustations on the teeth, gums, and tongue, in low fevers, bear a strong resemblance, our author thinks, to the matter of melanoses, as well as the discharges in melena and hæmatemesis. M. Breschet is disposed to think that jaundice is produced by the blood rather than the bile-an opinion founded on necroscopical observations made in the Hospice des Enfans, on the bodies of jaundiced foundlings. The yellow suffusion which takes place soon after birth can hardly, he imagines, be produced by bile. He thinks it more natural to attribute this phenomenon to changes which take place in the circulation, the same as we observe after contusions, &c. This is a very interesting and ingenious memoir, honorable to the author, and advantageous to the Journal in which it appears. 28. Tetanus.* Tetanus, especially of the traumatic kind, is so dreadful a disease, and so very often fatal, that every successful case should have all possible publicity, for the good of humanity and the honour of the profession.t Mr. Barr's patient was a young man, who, in falling from a horse, was trampled on the belly by the animal. He went about his usual avocations, however, for seventeen days, when he was, all at once, seized with tremendous universal spasms, bending the head and trunk in the form of a bow-but whether forward or backward is not stated. Mr. B. saw him an hour after the attack, and the spasms were then recurring every five * Mr. Geo. Barr, Surgeon, Kelsyth. Edinb. Journal, No. 71. ↑ Aretaus, with his usual terseness and forcible language, calls tetanus an "inhumana calamitas, injucundus aspectus, triste intuenti spectaculum, et malum insanabile." Modern medicine, on this, as on very many other ocasions, can boast of much more success than the ancient. Tetanus cannot now be called "malum insanabile," even were it more fatal than it is.-Ed. minutes. The neck was stiff and immoveable; and many of the muscles, especially the pectorals, felt rigid. The jaws were firmly locked. Our author instantly bled him, pleno rivo, to the amount of 50 ounces;* in about half an hour after which, the muscles of the jaw relaxed, and three fluid drachms of laudanum were exhibited. The spasms became less powerful and less frequent, having now an interval of half an hour. A drachm of laudanum was repeated after each spasm. At three o'clock next morning, the patient was again bled to 12 ounces; the laudanum, combined with two grains of camphor, to be continued as before. The spasms now returned about once in the hour, and not nearly so severe as before. Throughout the whole of the second day the paroxysms recurred once an hour, the jaws being completely locked during each paroxysm. Bled in the evening to 20 ounces. Having vomited the tincture, four grains of solid opium were ordered to be taken after each spasm. A nitric acid blister was applied to the whole spine. The spasms now occurred every two or three hours. On the third day some strong purgative pills, and three 15 grain doses of calomel were ordered to be taken. Had seven stools through the day, having taken the 45 grains of calomel. The spasms recurred this day every hour and half, and very severe. A drachm of solid opium was therefore given at once. In about 20 minutes the patient began to doze a little, but not to sleep-complained of giddiness, and some dyspnea. In an hour and ten minutes he fell asleep, shortly after which, the breathing became slow and very laborious, the number of respirations being four in the minute. The patient having continued in this state about two hours, Mr. B. roused him, when he felt nausea, which was succeeded by full vomiting on taking some warm water. This produced much relief. Fourth day. No spasms since last night, except one paroxysm at 10 o'clock this forenoon. Mouth sore from the calomel. Venesection to 16 ounces, the pulse being 100 and full. Fifth day. No spasms-mouth very sore, and saliva flowing gently. From this time he became convalescent, and soon recovered completely. We see in the above case that three powerful remedies were employed-venesection, opium, and mercury. We cannot therefore positively say which was the efficient medicine. Perhaps no one or two of them would have succeeded. The venesection prepared the way for the speedy operation of the opium and calomel. We have long been convinced that general and local (from the spine) bleeding, opium, and mercury, are the best means we possess of checking this formidable disease. These are the means indeed which have been employed of late years between the tropics, where tetanus is It appears from Celsus that Asclepiades was a great advocate for bleeding in tetanus. "Asclepiades utique mittendum sanguinem credidit." Celsus himself, among many other means, recommends cupping the spine, and then applying the actual cautery. We think this plan would probably be useful.-Ed. so prevalent. The dose of opium, in the present instance, we think was rather too large, though we are quite satisfied that in tetanus and some other painful diseases, such is the torpor or insensibility of the stomach, that opium and all other medicines may be taken in doses infinitely greater than the same patients would be able to bear in a state of health. Purgatives are useful auxiliaries in recalling sensibility to the ganglionic system of viscera, and thus lessening the quantum of irritation on the origins of the spinal nerves. All the phenomena, indeed, of tetanus would lead us to conclude that nervous irritation of a high degree is propagated to the spinal marrow; and that, upon a well known and universal principle (“ ubi irritatio ibi fluxus,") we may next expect the vascular system to be drawn, sooner or later, into a morbid state. The irritation, however, may be so great, and the spasms so violent, as to destroy life without leaving traces of vascular derangement on dissection. In many instances these vascular alterations have been detected; and whether they are detected or not, there can be no doubt of the nervous irritation in the first instance, and indeed throughout the whole of the disease, 29. Fractures of the Clavicle. Every surgeon knows the difficulty of keeping the fractured extremities of the clavicle in co-aptation. When this bone is broken, the internal portion is firmly fixed in its place by the costo-clavicular ligament, and by the opposite actions of the sterno-cleido and pectoralis muscles. It is therefore the external fragment which always becomes displaced. It is borne down by the weight of the arm and the action of the deltoid muscle, while it is, at the same time, drawn forward and inward by the pectoralis major, and thus carried under the internal portion, which forms an eminence over it. We all know that the figure of 8 bandage is very inadequate to the counteraction of the above circumstances. Desault invented an apparatus which appears to have been very successful in his hands, but not so in those of others after him. The plan of Mr. Charles Bell, by means of the double-headed roller and compress under the arm, seems better adapted to general application than that of Desault or Boyer. "But, says Dr. Brown, as the force exerted to keep the external portion raised in contact with the internal, depends upon the short turns around the shoulder, a very slight stretching of the bandage will occasion it to be displaced; and unless the bandage be frequently re-applied, it cannot be retained in its situation. "Take a single-headed roller, eleven yards long and three and a half inches broad,† and place one end of it a little forward of the A new mode of bandaging fractures of the clavicle. By Stephen Brown, M.D. of New York. Amer. Med. Recorder, No. XVI. ↑ A bandage narrower than this will, of course, be found more convenient in cases of children axilla of the opposite side; carry the roller from thence across the upper part of the chest under the armpit of the affected side, and around the body to meet the end, over which let it lap a little, and pin or sew it fast. Place a cushion in the armpit, as directed by Desault, which is to be attached to the bandage thus passed around the body by tapes, or, which is better, let it be sewed. The cushion being fixed, the surgeon seizes the patient's elbow, the forearm being bent to a little less than a right angle with the arm, and brings it forward, upward, and inward, pressing it closely against the body. Let the shoulder be sufficiently raised, so that the external fragment be carried up to its place, and the deformity entirely disappear. Let an assistant hold the elbow and forearm in this situation, while the surgeon brings the bandage down obliquely across the breast over the forearm nearly across its middle, passing it around under the elbow, and across the back obliquely upward to the lower part of the scapula of the opposite side. Here it should be pinned or sewed to that part which was first passed around the body; then with a turn carry it over the shoulder of the same side, and down obliquely across the breast, as before, overlapping the first cast about twothirds, and across the forearm, nearer the elbow than the first; carrying it around under the elbow, and up across the back, to he fas tened upon the preceding cast in the same situation where that was attached to the first. With a turn carry it over the shoulder, where it should nearly cover the preceding cast; then down across the breast as before, overlapping the preceding fold as the second does the first. Four or five of these casts over the forearm and elbow are sufficient. Let the last two or three embrace and support the elbow, with such a degree of force as to keep the shoulder well raised. Fasten the cast which was last carried around to as many folds of the preceding ones as it will cover, just forward of the elbow, upon the forearm;-then with a turn carry it over the arm just above the elbow, across the back, under the axilla of the opposite side, and around and across the chest, to be attached to the folds upon the forearm, as before. Then with a turn overlap the first cast, and carry it around in the same manner. "Two or three of these casts are sufficient; the object of which is to keep the lower extremity of the humerus closely in contact with the body, which, by the aid of the cushion, keeps the shoulder outward. The hand may be supported in a sling formed of the last extremity of the bandage, the last cast of which may be pinned In females in order to obviate, as much as possible, any inconvenience by pressure upon the mammæ, the casts which are carried over the humerus, when they are brought under the armpit of the opposite side, instead of being continued directly across the breast to the lower part of the humerus of the affected side, may be carried obliquely upward toward the neck, upon the casts that were passed over the shoulder; to which let them be fastened. Then with a half turn continue down upon the forearm near the elbow, and fasten again; then with a turn carry it over the lower part of the humerus, &c. &c. to the folds upon the back, and the end brought over the shoulder to the wrist; or, attached to the folds upon the breast, and the end passed around the wrist and hand once or twice, and fastened again. "Before applying the bandage, a cushion of several folds of soft linen should be laid upon the shoulder to prevent irritation, over which the folds of the bandage should rest. To answer the same purpose, the arm and forearm may be covered with a layer of soft linen, and a few folds of the same placed in the armpit of the opposite side. 66 The bandage being applied, let the casts, where they overlap, be sewed to each other in every situation where the bandage is most likely to be deranged. This is particularly necessary where they cover the arm and forearm. "This mode of bandaging will be found to possess equal facilities with the most approved plan of reducing fractures of the lower extremities."-Medical Recorder, No. xv1. p. 657. The 30. Protecting and Modifying Influence of Vaccination. unqualified protection of the vaccine process against variola, is now properly given up by all unbiassed practitioners. It is far better for either a man or a medicine, that his or its character and value should be precisely estimated and ascertained, than that either should be exaggerated above, or depreciated below, the standard of truth. Vaccination, like all other things in this world, must submit to the imputation of imperfection. Fortunately for itself, and for mankind, it can admit this draw-back, and still hold up its head with honour. It may be said of vaccination that, in most instances, it stems variola entirely-and in all, or nearly all instances where it fails in preventing, it so modifies the variolous disease as to leave it scarcely cognizable as the same affection. Is not this enough? Among the now innumerable proofs of the above position, may be found some cases and facts brought forward by Dr. James Reed in our respected cotemporary of Edinburgh, for April last. A stranger with variola from Glasgow fell ill at Kilmarlock, and died on the 13th day. The contagion issued from this focus, and its steps were equally well marked and distinctly traced. Its first attack was on a vaccinated girl." After a smart fever, the vesicular eruption did make its appearance; and moderate chicken pox, ending safely about the eighth day of eruption, was the consequence." Precisely opposite to the house where the stranger died, a mother and her infant at the breast (both unprotected) caught the contagion. In the mother, severe and confluent small-pox terminated fatally on the 10th day of the eruption. The infant escaped, but bears the permanent marks of variola. The husband of this woman (himself Dr. James Reed, of Kilmarlock. Edinb. Journal, No. 71. |