We entirely agree with this distinguished and observant physician, that, in all probability, the contagious or non-contagious nature of typhus is dependent, partly on the quantity or concentration of the eflluvium thrown off from the body, and partly upon the closeness or openness of the patient's apartment. Or we should prefer saying that typhus fever is in its nature contagious, but that the chance of its propagation from individual to individual is greatly dependent on the abovementioned circumstances.

We are sorry that the limits of a periscope will not permit us to present a full analysis of Dr. Armstrong's ingenious paper. We recommend a careful perusal of the original to our readers.

While we cannot bring ourselves to coincide entirely with Dr. Armstrong on certain etiological points, we differ from him with great diffidence, because we hold his talents and character in the highest respect and esteem.

While on the subject of typhus, we may allude to a curious account of a "sporadic abdominal typhus," described by our young friend, Dr. Autenrieth of Vienna, in a late No. of the Edinburgh Journal. This disease, which he thinks has not been noticed by authors, chiefly attacks people in the higher classes of life, and generally occurs either during, or shortly after the years of puberty. The symptoms are nearly the same as in the low and insidious forms of common or contagious typhus; but it arises without contagion, and the seat of the complaint is the nervous system of the abdomen rather than the brain. "A vomiting, followed by a dull pain between the stomach and navel, is quite characteristic," of this abdominal typhus. From the minute detail of symptoms, the disease does not appear to happen often in this country. In Dr. Autenrieth's own case, the complaint lasted three months. In the dissection of patients who die during the abdominal stage of the fever, that is, from the 11th to the 17th day, "there is found a peculiar inflammatory state of the nerves, principally those of the abdomen." An exudation of reddish serum was observed along the fasciculi of nerves, and the medullary substance itself was penetrated by a dark-coloured cruor. The stomach and intestinal canal, at the same time, exhibited rose-coloured inflamed spots. If the patient dies at a later stage of the disease, the usual appearances seen in common contagious typhus, will be then observed. If the above phenomena, especially as regards the abdo

paper in the 72d No. of the Ed. Journal, p. 385. An athletic soldier caught fever, in Ireland, but the source of the disease could not be ascertained. While bleeding the patient one day, he breathed full in our author's face, and the impression was particularly disagreeable. He predicted that in eight or ten days he would have fever. He was seized on the ninth day, and nearly died of the fever. The soldier's wife came to see her husband, and was seized on the tenth day from her arrival. Five other soldiers, who occasionally visited this man, caught the fever. We think these are pretty authentic proofs of the existence of contagion.→ Rev.

minal nerves, be correct, and we know Dr. Autenrieth to be a young gentleman of great probity and talent, then we must cultivate neurotomy more than we have done, while prosecuting our pathological researches.

The statements of Bal

2. Reunion of entirely separated Bone. four and others leave no doubt, we imagine, in the minds of medical men, that soft parts, and soft parts containing bone, have been reunited after complete separation from the body; but we do not remember ever to have read of the reunion of denuded and detached bones. The present instance, therefore, is curious, and may be useful both in a physiological and surgical point of view.

Re

Professor Walther having trepanned a dog and returned the disc of bone to its place, found that it united with the corresponding edges of cranium. Soon after this, a mason, addicted to spirituous liquors, received a blow, by a stone, on the head, which produced moderate symptoms of concussion, that were treated in the usual way. The accident, however, was succeeded by such pains in the head, as induced the man, after trying various remedies, to beg for the operation of the trephine to be performed. Professor W. consented, and a disc of bone was removed, but the dura mater was found healthy. The bone, after being deprived of its periosteum, was returned, and the integuments drawn over it. The febrile symptoms were moderate, and the signs of meningeal inflammation by no means severe. union of the integuments did not take place-suppuration ensued the discharge continued some months-and the patient found himself better of his head-aches, which gradually diminished, and ultimately disappeared. At the bottom of the wound the osseous disc could be felt loose. Professor W. thinking, at the end of the third month, that it ought to be removed, seized it with the forceps, but was surprized to find that, instead of bringing away the bone entire, a thin, angular, and ragged portion, consisting only of part of the external table, was removed. The inferior surface of this portion was rough and unequal-one of its margins round, the other pointed and serrated-in a word, the vitreous table of the separated disc, and a part of the external lamella, were reunited; while the larger portion of the latter was exfoliated. On attentive examination of the bottom of the wound by the probe, "the original parietal opening was found thoroughly closed, and filled by osseous matter, hard, and covered by healthy granulations." Professor W. justly concludes that, as exfoliation and granulation could only take place in a part where there was an active state of its vessels, so it was evident that the reunited portion of bone retained its vitality, and, in this case, formed vascular connexions with the dura mater, and with the diploe, thus becoming subject to the usual processes of nutrition and vascular action. The wound gradually healed.

• Professor Walther of Bonn. See Med. Repos. 102.

3. Metastasis. Among the various means by which Nature carries off noxious matters from, or prevents morbid processes in, the system, there is one, which is generally considered an evil at the

time.

vera bona.

pauci dignoscere possunt

This is a fœtid perspiration from the feet. There are many examples on record where attempts to restrain this disagreeable secretion have been followed by bad consequences. Raymond informs us, that a nun had long been afflicted with a purulent discharge from the eyelids, which, at the age of 22, changed to copious and fœtid sweats from her legs and feet. While she submitted to this inconvenience, her eyes continued strong and healthy. At length, however, these fetid perspirations became very disagreeable to herself and her associates, and, therefore, she bathed her extremities in astringent lotions, which arrested the cutaneous discharge, but brought on epilepsy, which continued, with intervals, for three years. The epilepsy now disappeared, and the patient became affected with scrophulous ewellings in the neck and axilla. From these parts, there was ultimately a translation to the lungs, of which the patient died.

Reydellet records several instances of nearly a similar nature, and Dr. Thomas Harris, in an interesting paper on metastasis, published in the 17th No. of our very respected cotemporary, the AMERICAN MEDICAL RECORDER, has related a case, the particulars of which, we shall here introduce to our cisatlantic readers. Dr. H. was called to a lady, in March last, affected with severe pain in the back and head, with great depression of spirits, and occasional symptoms of hysteria. She was treated by our author for nearly a month, without experiencing any relief. About this time, she informed Dr. H. that she had lately gotten rid of an old companion (as she termed it) which had been extremely offensive to herself and her friends-namely, a copious and fetid perspiration about the feet, which had succeeded a scrophulous swelling in the groin of long standing. These perspirations had continued three years, during which she enjoyed uninterrupted health, until lately, that she had caught cold by getting wet feet. Our author very judiciously took the hint, and prescribed pediluvia, the vapour bath, and emollient poultices. The fetid sweats returned, and with them, good health and spirits.

The study of metastatic affections, both in a pathological and therapeutical point of view, is not sufficiently attended to by modern practitioners. We agree with Dr. Harris that it should be laid down as a rule of practice, in every chronic disease-"to favour a metastasis to the surface." When the disease exisis in the cutaneous expansion, it will be no less the duty of the practitioner to guard against a translation from that, to an internal structure.

4. Axillary Aneurism. Our surgical brethren are well aware how few successful cases (or even attempts) there are on record of the kind now before us. We conceive that, next to the aorta itself, the subclavian artery is the least accessible to the ligature, especially in the living subject, and where disease has deranged all the relative position of parts. Mr. Todd is entitled to the greatest praise for his intrepidity and dexterity in an operation of such tremendous difficulty and danger.

The patient (John Dundas) was 53 years of age when he entered the Richmond Hospital, on the 21st of January of the present year. He stated, that he had been uniformly healthy and temperate till early in June 1821, when he felt a stiffness and numbness in two of the fingers of the right hand, which, in a month, was attended with inability to close the fingers. The hand then, and ultimately the arm, became ædematous. In October of the same year, he perceived a small tumour in the axilla, which rapidly encreased, attended with weight, pain and pressure. He went first into the Fermanagh Infirmary, and from thence was transported to the Richmond Hospital. The aneurism, at this time, not only distended the axilla, so as to cause the scapula to project considerably backwards, but it was very prominent anteriorly-its base extending upwards to the clavicle inwards to the edge of the sternum-downwards to the nipple of the breast and on the side of the thorax, to the upper edge of the sixth rib. The tumour was tense, elastic, and pulsating-the skin feeling stretched upon it, but not discoloured-slight pressure did not give pain; but the patient complained of deep-seated uneasiness. The whole extremity was oedematous, and the elbow separated to a great distance from the side. No pulsation could be perceived in the radial or ulnar artery of the diseased limb, but there was little diminution of animal temperature.

On the 25th of January, the pain of the arm was so intense, and the size and pulsation of the tumour so much increased, that venesection and opiates were necessary. No permanent advantage being gained by any means pursued, it was determined to have recourse to the operation, which was performed on the 8th of February, in the presence of several surgeons of the Irish metropolis. We deem it proper to give the steps of the operation in Mr. Todd's own words.

"The patient was placed on a table, lying on his back, with the upper part of his thorax somewhat raised; his head and neck inclined to the left, and his right shoulder as much as possible depressed by an assistant steadily drawing down the arm of that side. A slightly curved incision was made through the common integuments across the lower part of the neck, commencing about two inches above the acromial, and terminating half an inch above and to the outer side

A Case of unusually large Aneurism of the right Axillary Artery; in which the Subclavian Artery was tied. By CHARLES H. TODD, Esq. Senior Surgeon to the Richmond Surgical Hospital. Octavo, p. 13. Dublin, 1822.

of the sternal extremity of the clavicle. The convexity of this incision was downwards, so that by a little dissection of the integuments upwards, a small flap was made, which afforded ample room for the subsequent stages of the operation, and evinced the inutility of a more extensive, or a more complicated division of the skin.

"The next part of the operation consisted in dividing the platisma myoides, fascia, and subjacent cellular tissue; this occupied a considerable time, in consequence of the great number of veins which it was found necessary to secure with ligatures. The external jugular, and two or three other superficial veins were easily secured, but a series of more deeply seated veins proved extremely troublesome; one branch of these in particular poured out blood in an alarming quantity, and receded so much within the layers of the fascia, that Ï was at last compelled to use the needle, and to include in the ligature the portion of fascia with which the divided vein was connected.

"I feel it incumbent on me here to state, that this profuse discharge of venous blood was chiefly the consequence of the veins having been divided too near the large trunk into which they opened; the blood therefore flowed freely in a retrograde direction from the subclavian vein into them, and issued from their inferior orifices; the bleeding from their superior orifices was inconsiderable and easily controlled. To have tied these veins individually, before dividing them, would have been an undertaking both tedious and difficult to execute, for they constituted a most intricate plexus of convoluted vessels imbedded in cellular tissue and layers of fascia.

"The venous hemorrhage having been at last effectually suppressed, I proceeded to search for the omo-hyoideus muscle: so much however was the relation of parts altered by the magnitude of the tumour, and consequent elevation of the clavicle, that the portion of this muscle expected to be brought into view in this stage of the operation, was situated more than an inch below the clavicle; and it was found necessary to draw it up from its concealment, and to cut it across, that the subjacent parts might become accessible.

64

Having applied my finger to the edge of the scalenus anticus, I was directed by it to the situation of the artery; but at this juncture causes of further difficulty arose, chiefly from the great depth of the wound, and the doubt which the almost total absence of pulsation in the artery naturally excited in regard to its identity. It is necessary however to observe, that this obscurity in the pulsation of the subclavian artery was by no means referrible to the debility or exhausted state of the patient, but probably depended on the vessel having been flattened upon the first rib by the degree of extension to which the aneurismal tumour in the axilla had subjected it.

"For some time I could not be convinced that the feebly pulsating vessel, to which the point of my finger was applied, was really an artery of such magnitude as the subclavian; and aware of the disappointments which others were reported to have sustained in this operation, I resolved to satisfy myself and my assistants upon a

"See Sir Astley Cooper's case in Lon. Med. Review, vol. 11. and