following phenomena :-moderate pyrexia-cerebral functions undisturbed-respiration laborious-abdomen somewhat tumid-pulse irregular-tongue white countenance pallid lower extremities ædematous-skin of the forehead, chest, and back covered with a pustular and crustaceous eruption, which, in our author's opinion, indicated the existence of syphilitic virus in the system. The state of the patient forbade the use of mercurials, and therefore only aperient drinks were prescribed. The breathing now became hourly more and more difficult-the patient could not lie down-the thorax, on percussion, emitted a sound indicative of effusion-the heart beat over a great extent of surface, which indicated lesion of that organ. He died on the ninth day after entering the hospital. Dissection. Both cavities of the chest contained serous effusionheart considerably enlarged-parietes of the left ventricle thrice their natural thickness, but soft and flabby. Both the mitral and tricuspid valves were fringed with numerous venereal vegetations, of different sizes. Auricles natural. When, to the more common symptoms accompanying organic affections of the heart, we have added irregularities in the pulse, we have always found it a very unfavourable omen, as it almost invariably indicates valvular disease—the worst species of cardiac lesion. We e were lately in attendance on a dreadful case of this kind, with Dr. Farre, Dr. Walshman, and Mr. Browne, a very able practitioner of Camberwell. The symptoms were such as above described, with the addition of a tremendous regurgitation into the internal jugular veins, which pulsated like immense arteries. The struggle of the patient with this fatal disease was long, and afflicting to himself and friends. At length he sunk from hydrothorax, and serous effusions in all parts of the body. 15. Tobacco in Phlegmasiæ. Dr. Page has related three cases of phlegmasia, where nicotiana in glyster was employed as an auxiliary; but it is only on the first case we shall animadvert. A woman of plethoric habit was seized with pneumonia, and after bleeding, blisters, and a dose of salts, she has an opiate draught given her at night, notwithstanding great dyspnoea. This practice was persisted in, and we have no hesitation in saying it was bad practice. Antimony should have been given, as the grand auxiliary to venesection, and this would have done all that the tobacco glysters effected, in a far more safe and manageable manner. 16. Flux of Blood from Hepatic Enlargement. Dubuc, a * Dr. Page. Ed. Journal, No. 72. watch-maker, 45 years of age, of pale complexion, but formerly in good health, had had a fall on the right side against a hard substance, since which time (three years ago) he has felt occasional pain in the region of the liver. He entered the HOTEL DIEU on the 26th August, 1815, complaining of pain in the abdomen, the liver being evidently enlarged, and projecting beyond the false ribs. There was constipation of the bowels, dryness of the skin; but no fever. Leeches were several times applied to the anus, with diluents sedatives-warm baths. On the 31st August, the patient began to pass considerable quantities of blood by stool, of a black colour, and mixed with some focal matters of stercoraceous smell. This evacuation rendered the abdomen less painful, as well as the immediate region of the liver, which became less tense and prominent.* These favourable symptoms led to the further application of leeches to the fundament, with diluent drinks, and emollient lavements. The discharge of blood continued about a week, when it ceased; the patient experiencing pains in the region of the liver only occasionally. The constipation of bowels obliged him to have recourse to lavements twice or thrice a day, in default of which the abdomen swelled, and the right hypochondrium became painful. By degrees the patient regained his strength-the constipation of bowels gave way-the stools became natural-the complexion more healthy. By the end of September the patient was discharged cured. We shall take frequent opportunities of impressing on the minds of our brethren in this country the necessity of paying more attention to anal leeching, and the introduction of enemas in their practice. We are quite convinced, that in neglecting these measures we deprive ourselves of powerful auxiliaries in the treatment of diseases. Оп 17. Luxation of the Hip-Joint.+ Dislocation of the larger joints occasionally happen in places where we have but slender assistance, and simple mechanical means of reduction, It is therefore well to be acquainted with those instances where the reduction has been effected without the aid of machinery, as in the following case. the 28th of January, 1822, a soldier, 38 years of age, of very robust habit, was violently run against and upset by a stage coach, in turning one of the streets of Paris. He was with difficulty got into a cabriolet and conveyed home, where M. Devilliers immediately saw him, and recognized a luxation of the thigh bone, by the * This verifies the ancient medical precept in Serenus Samonicus, "Si modicus pleno manat de corpore sanguis "Subvenit:—at nimius cum vita funditur ipsa." Serenus Samon. de Med. Præcept. †M. Devilliers. Journ. Gen. de Medecine, Fevrier, 1822. following signs, viz. remarkable shortening of the member-rotation of the toes outwards-the knee abducted beyond the median linea tumour in the right groin near the pubis-a depression in the situation of the cotyloid cavity-inability to place the limb in its natural posture. These signs indicated a dislocation upwards and inwards of the head of the femur. At this time there was only one person in the house capable of rendering the surgeon any assistance, and the latter was loth to lose time by sending for assistance elsewhere. Causing this person then to take a firm hold of the patient's foot, he bent the knee, and grasping the ham with his right hand, he placed his left on the site of the tumour in the groin. Thus situated he gave the thigh bone (that is the knee) a sudden rotatory movement inwards, upwards, and forwards, while counter-pressure was made on the tumour, or opposite extremity of the femur. The head of the bone instantly snapped into the socket with a considerable noise, without much difficulty, or pain to the patient. Repose, cold applications, leeches, and the usual routine of treatment completed the recovery. 18. Introduction of Foreign Matters into the Blood. M. Majendie pursues his physiological career with great eclat, and his contributors are daily increasing, both in number and respectability. The physiological Journal before us bids fair to have a most extended circulation, and we shall, in future, pay our respects to its contents more frequently than formerly. It has been observed, in all ages and countries, that the introduction of putrid and unwholesome substances into the system, as food, has been generally followed by fevers and other malignant diseases, as the histories of famines too fully prove. The experiments which have been undertaken by Dr. Gaspard, may, it is to be hoped, throw some light upon the subject; and are therefore deserving of being widely known. The first series of experiments, ten in number, consisted in the introduction of purulent matter (generally a little diluted with water) from common ulcers, into the veins and certain cavities of the bodies of dogs. Before giving the conclusions to be drawn from these experiments, we shall sketch a few of the experiments themselves. Exp. 1. Into the jugular vein of a dog two drachms of diluted pus were injected; The animal, at the moment of injection, became agitated, and went through the action of vomiting. He whined, appeared weak, and vomited more than six times in the course of the day. An hour after the experiment there was an evacuation of Memoire Physiologique sur les Maladies Purulentes et Putrides, sur la Vaccine, &c. Par G. Gaspard, M. D. Journal de Physiologie, par F. Majendie, Membre de l'Institute, &c. January, 1822. excrements, and of thick, troubled urine, which gave some relief. Towards evening, however, he lay sick on the ground, with his legs stretched out, the respiration insensible, and the pulse weak. Ten hours after the experiment he passed blackish, liquid, and extremely fetid stools, which brought about relief, ending in recovery. Next day the dog was well. Two days afterwards three drachms of pus were injected into the other jugular of the same dog. The symptoms were in a more violent degree, and death supervened within the 24 hours. Dissection displayed no alteration in any organs. Similar experiments were again made on a dog, one on the 15th, the other on the 18th September. In the first the dog recovered, after frequent evacuations-in the second experiment he died, and on dissection the inferior portions of the lobes of the lungs were inflamed and nearly hepatized. In another experiment, where three drachms of pus were injected, the animal died in great agony of tormina and tenesmus, at the end of five hours. On dissection, the intestines appeared thickened externally-their mucous membrane was inflamed and swollen, especially in the colon and rectum. In an experiment made on the 21st of September, where half an ounce of pus rather older and more putrid than in the former experiment, was injected, frightful nervous symptoms ensued, as wandering vision, excited sensibility, convulsions, hiccup, staggering, furious delirium, burning thirst, dyspnea, palpitation, death in two hours, amid dreadful convulsions. On dissection, while the body was yet warm, the venous blood was found very coagulable-the pericardium contained a little effused serum-the left ventricle of the heart was thickened and inflamed, presenting, on its inner surface, spots of the colour of wine lees--the other organs healthy. In two experiments, where pus was introduced by the serous membrane of the testicle into the abdomen of dogs, without producing violent pain at first, there soon came on vomiting, evacuation of urine, fever, and dyspnoea. In three hours the abdomen was convulsed, drawn in, and very painful on pressure. Death ensued in twelve hours. In the first dog the peritoneum was found reddened and rather inflamed, with about an ounce of bloody inodorous serum. The mucous membrane of the intestines was rather red and inflamed. In the second dog, the peritoneum was inflamed, and contained a small glassful of sanguineous serum, of a fetid odour. The mucous coat was a little inflamed. Introductions of pus into the cavity of the pleura produced nearly similar effects. When introduced into the cellular texture, it was not absorbed and only gave rise to a hard inflammatory tumour ending in suppuration. From the ten foregoing experiments our author thinks he may legitimately draw the following conclusions. 1st. That pus introduced, in small quantities into the circulation causes considerable derangement of function, from which, however, the animal recovers, after the offending matter has been expelled from the system by means of a critical excretion of urine, or of focal discharges. 2d. That when it is introduced at successive periods into the same animal, death is the result. 3d. That when injected into the veins, in a large dose, it produces severe inflammation, namely peripneumony, carditis, dysentery, &c. 4th. That it appears susceptible of being absorbed, causing inflammation of the serous membrane and cellular tissue, with which it had been in contact. 5th. That the majority of symptoms occurring in hectic fevers, appear to admit of being referred to the presence of pus in the circulation. Our author is also inclined to infer that, the phenomena exhibited in the course of cancerous ulceration, old dropsies, mercurial ptyalism, gangrenous affections, drunkenness, &c. may be attributed to the absorption of a portion of morbid matters into the blood. He thinks, that absorption frequently takes place in various diseases characterized by suppuration, either through the medium of the veins, or of the absorbents, or of both-as will be made more probable by experiments presently to be detailed. In the 11th experiment, the author threw into the jugular vein of a young sheep, an ounce of cold water, in which had been dissolved six vaccine crusts recently taken from the arms of children, to which was added, a large drop of vaccine matter from an eight day vesicle. On the introduction of this liquid, the animal went through the action of swallowing, but without evincing pain. The animal suffered no inconvenience, and had no cutaneous eruption afterwards. A similar experiment was performed on a little bitch, four months old, and which had not had the "maladie de chiens." Half an ounce only, of the vaccine solution was thrown in. In an hour the animal refused food and vomited. The vomiting was renewed many times, accompanied with burning thirst, evacuations of urine; and uneasiness which lasted all the day. Next day, however, all was well, and no eruption appeared. In two succeeding experiments, putrid sanies was thrown into the jugular veins of dogs. In the first, the animal went through the act of swallowing during the injection, and soon after had dyspnoea, uneasiness, and faintness. It lay on its side, refused food, and soon after passed excrements and urine. In an hour, there came on prostration of strength, dysenteric stools, redness of the conjunctiva-pain on pressure of the chest and belly, bilious and bloody vomitingdeath at the end of three hours. On dissection, the lungs were found inflamed in a peculiar manner, or rather congested. They had a violet colour, and on them, as well as on the left ventricle of the heart, the spleen, the mesenteric glands, gall-bladder, and subcutaneous cellular membrane, were seen ecchymosed spots or petechia. The peritoneum contained some spoonfuls of reddish serum. The mucous membrane of the stomach was somewhat inflamed-that of the intestines greatly so, with black spots, and a bloody gelatinous covering, like wine lees, or the wash |