We agree with Mr. L. that, in general, when we are cutting down, in the living subject, on a strangulated hernia, we look in vain for the distinctions between fascia which may be demonstrated in the dissecting room-or rather we should say, that we shall find more fascia than we expected, and that inflammation often converts common cellular tissue into apparent lamina of fascia. We agree with Mr. Lizars in another point, namely, the difficulty of distinguishing between crural and inguinal hernia in women. In an early period of our professional career, we lost a sum of money by betting with a colleague that a hernia, of which an old woman died, was of the inguinal kind, when dissection shewed it to be crural. We have, since that time, seen some able surgeons puzzled, and even deceived on the same subject. It appears, from Mr. Lizars, that, instead of advancing in the knowledge of inguinal anatomy, we are retrograding. "Work after work," he says, "has been published on the subject, and the more and more confused and intricate are the descriptions." Vesalius, Eustachius, Cowper, Albinus, Douglas, all have erred-and the anatomy of Hernia "may be pronounced the arcanum of surgery." From this disconsolate representation we gladly turn to a prospect more cheering-that of curing hernia (reducible) in men, women, and children, without any surgical operation at all. It is well known that the skin and other textures of an animal, when dead, are hardened and strengthened by tanning --why not tan them alive? The idea has been long acted on, as far as the stomach is concerned. That organ we are daily in the habit of tanning with bark, steel, astringent wines, &c.. The transition was very natural to the parts through which a hernia descends. For many years past our author has used for reducible hernia“ strong decoction of oak bark with wonderful success." Now, although we do not deny that the success might be wonderful, yet we do not like the expression, "wonderful success," from the mouth of a regular surgeon. Be that as it may, we think the proposal, as it is perfectly harmless, is well worthy of a trial, and we freely contribute to make the measure extensively known. A few pounds of oak bark are to be macerated in a sufficient quantity of cold water, for twelve or twenty-four hours, and then the bark and solution must be put into a larger vessel, and kept at the boiling temperature over a gentle fire for two or three days, adding, when required, boiling water, from time to time, so that the bark may be always covered. The solution should be ultimately strained, and evaporated to the consistence nearly of an inspissated juice. When used it should be warmed, to suspend the astringent matter. The hernia being previously reduced, the groin is to be bathed with the decoction, and the truss applied, three or four times a day. Mr. L. has cured hernia of many years standing, in this way, in the course of a few weeks. In general, however, it requires a perseverance of three months. This invaluable remedy was first mentioned to our author by a merchant, who cured himseif after having laboured under the disease for many years. In conclusion, we are exceedingly sceptical as to the tanning proVol. III. No. 10. 8 G cess on the living tendinous expansions composing the apertures through which berniæ protrude. 10. Inguinal Hernia, attended with peculiar circumstances. John Morize, a young lad of eighteen years, entered the MAISON DE SANTE with strangulated inguinal hernia of the right side, which had continued thus three days. When admitted, there were acute pains in the inguinal region-tension of the abdomen-violent colicbilious and stercoraceous vomitings-hard pulse and flushed face. Such threatening symptoms demanded the operation immediately, and it was performed on the spot. As soon as the sac, which was very thin, was opened, a knuckle of intestine presented itself of a deep brown colour, and with several livid spots, some as large as the finger nail. On the right side of the knuckle of intestine was observed a round, smooth, and brown coloured protuberance, about the size of a nut. The ring being divided, the intestine was returned with the greatest care and caution; in doing which, the little tumour abovementioned burst, and discharged full two table spoonfuls of black blood, thick and fetid. Morize was now put to bed, and diluent beverage prescribed, together with emollient lavements twice a day. Nevertheless, the abdominal pains continued, together with the stercoraceous vomitings, and obstinate constipation. On the second day, in addition to the above symptoms, the pulse was feeble, the look fixed, and the features decomposed. On the third day, when every thing indicated a fatal termination, the alvine evacuations appeared-the vomitings ceased-sleep supervenedand all the bad symptoms quickly vanished. It would appear, from the foregoing case, that the strangulated portion of intestine had suffered so much in its vital powers, and even physical structure, as to be a long time in regaining its proper functions after the stricture was removed. The case, while it offers no ground for delaying the operation beyond a reasonable period, holds out a hope that, even when at a late period, the operation may be successful, as nature has great restorative powers in reserve for emergencies like the above. 11. Emetics in Constipation. Dr. Hosack, of New York, has published some observations on this subject, which we shall briefly notice. In the year 1796, Dr. H. communicated to Dr. George Pearson of this metropolis a remarkable instance of constipation of the bowels yielding to blood-letting and the exhibition of mercury to ptyalism, after the disease had continued twenty-one days. Reflecting upon the manner in which mercury operates in relieving cases of this nature, after the gums have become affected, it M. Dubois. Annuaire Med. Chir. occurred to me that the action of this metal is not only by its effects upon the secretions in general, but more especially upon the biliary organs. The dark coloured and acrid discharges that succeed to this operation of mercury, appear favourable to this explanation. In like manner, the general derangement of the digestive organs, the foul tongue, the offensive breath, the sallow complexion, that usually precede and attend upon the first stage of this disease, no less point to this obstructed and torpid state of the liver, as having great agency at least in predisposing to the disease in question, while a check of the perspiration, and certain articles of diet, are not unfrequently the exciting causes of irritation, and of the spasm and inflammation which ordinarily constitute an attack of this complaint. With these views I was led to the use of emetics, as best calculated to remove the hepatic obstruction which appears to lay the foundation of this disease, while by their febrifuge and anti-spasmodic operation they are no less useful in removing the fever, the inflammation and constriction that constitute some of the most distressing, as well as dangerous symptoms, that attend a constipated state of the belly." Med. Repos. No. 103, p. 78. Dr. H. proceeds to relate several cases in illustration, of which we can notice but one or two in this place. Case 1. Mr. W. B. had been relieved by mercury in severe constipation on a former occasion, but was now again seized with obstinate obstruction of the bowels. His countenance was sallow, his tongue furred, breath offensive, stomach disturbed, but the arterial system tranquil. An emetic of tartarized antimony operated freely, producing a general relaxation of the system, and discharging by vomiting dark coloured viscid bile, that appeared to have been long pent up. Copious evacuations by stool succeeded, and the patient was instantly relieved. The second case was that of a merchant, who had been several times previously relieved of dangerous constipation by mercury, and who was lately visited by a severe attack of the same kind. Dr. H. found pain and violent constriction of the bowels, small pulse, sallow and livid countenance. He gave him fifteen grains of hippo and two of emetic tartar. The medicine operated freely both upwards and downwards, and the patient was immediately relieved. The other cases are nearly of a similar nature to the above, and need not here be detailed. We shall, however, introduce to our readers Dr. Hosack's conclusions from the above and other facts which he has stated. "1. That a constipation of the bowels is naturally attended with, and frequently produced by, a torpid state of the liver, and consequent deficiency of the biliary discharge. 2.-That the pain, spasmodic constriction, and inflammation, attendant upon this disease, are the result either of the mechanical obstruction occasioned by the deficiency of bile, and, consequently, a retarded peristaltic movement of the intestines, or the effect of a sudden change of perspiration, or of a particular article of diet. 3. That in the commencement of constipation, or in its more advanced stage, when the symptoms of inflammation have been subdued by the lancet, emetics may be very advantageously exhibited, both for the purpose of removing the hepatic obstruction, and of counteracting the spasmodic constriction and pain ordinarily attendant upon this disease, 4.-That the salutary effects which have been occasionally derived from injections of tobacco smoke are attributable to the general relaxation, the nausea, and, in some cases, the vomiting, which that narcotic produces. "5.-That the benefits that have, in like manner, been obtained in some cases from the use of tartarized antimony, administered by injection, are to be accounted for by the nausea and vomiting that have been the effects of its operation, but which are to be obtained with more certainty from the same medicine given by the stomach, and to the extent of full vomiting. "In like manner, inasmuch as a torpid state of the liver and a diminished secretion of bile are generally known to constitute a part of the proximate cause of dysentery, we obtain a satisfactory solution of the salutary operation of injections of ipecacuanha in that disease, as advised by Dr. Thomas Clark; but which effects are more certainly to be obtained from the use of ipecacuanha given by the stomach, as prescribed by Sir John Pringle, or of tartarized antimony, as recommended by Senac.'" P. 81. There can be no doubt that a deranged function of the liver is very often a cause of constipation as well as of several other affections of the intestinal canal; but we cannot help viewing Dr. Hosack's theory as rather too exclusive. We do not see, however, any material objection to the practice recommended by Dr. H. Indeed, we have long been convinced, and have often stated our conviction in this Journal, that the judicious and timely exhibition of emetics is too much neglected in modern practice-purgation appearing to absorb the attention of the physician almost exclusively. 12. Belladonna.* Mr. Thompson has made some observations on belladonda in neuralgic affections, and related two cases in illustration. The dose of this medicine, he thinks, should seldom be less than two grains of the pure extract—and sometimes, when pain is excessive, three or four grains, repeated at intervals of five or six hours, till its effects are manifested, may be necessary. The observation of Haller, however, must be borne in mind, that permanent blindness has resulted from the use of belladonna. Its effects on the system therefore should be carefully watched. The first case related by Mr. T. was that of a lady, who became affected with excessive pain in the centre of the left tibia, which would continue • Mr. Ed. Thompson. Med Repos: 103. Nothing was appa a few hours, then abate, and at length cease. rent in the limb, nor did pressure occasion any pain. She tried a variety of internal and external remedies without any benefit. She was desired to take two grains and a half of extract on an empty stomach. The consequent vertigo, faintings, and dimness of sight, were such as to keep her in bed all the next day. For thirty or forty hours she could not raise her head from her pillow, without experiencing a strange and disagreeable sensation. The pain of the leg left her, however, and did not afterwards return. In the second case, a gentleman had been seized in March with racking pains in the gum of the left side, extending along the face, for which a tooth was removed, without producing any relief. He was leeched, blistered, and took opiates, without benefit, and then another tooth was extracted, but still the pain continued. Two grains of the extract of belladonna were given, and repeated. The four grains produced slight delirium, and great vertigo. These symptoms soon left him, and the pain returned no more. 13. Over-Dose of Opium. On the 2d of March, 1794, a Mogul gentleman swallowed about 150 grains of opium, and was found, in less than an hour, in a state resembling profound intoxicationhis skin of a red inflamed colour-all the veins greatly distended. When roused a little, he complained of an intolerable itching all over his skin-pulse from 70 to 80, full and soft. Fifteen grains of sulphate of zinc were administered, and ten grains more every ten minutes. This produced but slight vomiting. Fifteen grains of the zinc were then given every ten minutes till full vomiting was effected. He took in all 125 grains of the sulphate. He quite recovered. Vegetable acids were given after all smell of opium disappeared from the ejected matters. 14. Venereal Affection of the Heart. Corvisart and most of the French pathologists insist on it that the venereal virus falls occasionally on the heart, and there evinces itself particularly in the form of syphilitic excrescences, or vegetations on the valves of the organ. We have met with three cases of this kind, in middle-aged men, but where there was no evidence, at the time of their death, that they had laboured under incompletely eradicated syphilis. Still, as M. Dubois observes, the causes of a disease may be removed, but the effects may long remain. The following case is in point. "Claude François, a jeweller by trade, aged 34 years, entered the MAISON DE SANTE on the 18th October, 1818, presenting the Dr. A. Kennedy. Ed. Journal, No. 72. M. Dubois. Annuaire Med. Chirurg. |