illness a stercoraceous vomiting, which had previously recurred at intervals of from forty to fifty days, had ceased altogether for more than two years. No secretion of urine, nor evacuation per anum had taken place since the commencement of the disease, in 1820; neither during all these years had there been any traces of activity in the generative organs. Strange that with such a defect and morbid state of the alimentary and urinary organs, the general health of the patient should have continued moderately good. Towards the close of the year 1831 he had a threatening of the return of his thoracic complaints; but they were speedily removed by appropriate treatment. Occasionally too, when he eat any food which disagreed with his stomach, or took it at improper times, he was seized with alarming symptoms of cramp and ineffectual efforts at vomiting. One of these attacks which had been brought on by a repast of fried sardinias, nearly proved fatal in the Spring of 1832; for fifteen days his life was despaired of; fortunately then a spontaneous vomiting occurred by which he rejected four large masses of solid stercoraceous substance, which seemed to have been impacted in the intestines. Nature having thus relieved herself of an immense accumulation of fæcal matter, which had been gradually collecting for a space of nearly three years, the health of the patient was speedily restored to its former condition. It was necessary every now and then to take away a small quantity of blood by venesection, to counteract in some degree the stimulating and plethoric effects of the ardent spirits which the patient was inthe habit of drinking.

In the Summer of the following year Dr. Montesanto makes the report, "that his patient's health for the last twelvemonth has been on the whole exceedingly good; and that there has been no return of the stercoraceous vomiting during that period."

The paralytic state of the lower half of the body remained unchanged; all sensibility quite gone, but the limbs not wasted, and though motionless at will, were supple and flexible.

VOL. XXI. No. 41.

The authentic particulars now related have attracted the attention of many of the most distinguished physiologists and surgeons in Europe; the case altogether is one of the most wonderful on record-the mode of existence in this man being allied to the normal condition of life in some of the lower classes of animals.-Annali Univ. di Medic., Agosto, 1833.

CASE OF APPARENT DEATH [LIFE!]

WHICH LASTED FOR THREE WEEKS.

A young man who had recently been cured of a tertian fever, was admitted into the hospital at Paderborn, under the care of Dr. Schmid, for symptoms indicating tubercular phthisis. He gradually became exceedingly emaciated, and at length died.

After all traces of breathing had ceased, a few irregular beats of the pulse were felt, and the eyes opened of themselves. Some small eschars artificially produced exhibited signs of suppuration on the second, third and fourth days. On the fifth, one hand was found to have been turned round; and on the sixth and ninth days a partial perspiration bedewed the skin. After this period several pemphigus-like bullæ made their appearance. The limbs remained quite pliant; the lips preserved their red colour until the eighteenth day, and the expression of the features even at this date was that rather of a living than of a dead person. At the end of the third week there was no offensive smell nor any other sign of putrefaction. -Journ, der Pract. Heilk.

PRESERVATION OF LEECHES.

M. Bertrand recommends that leeches after they become detached from a part should be gently passed between the thumb and fingers, (or, as it is vulgarly called, stripped) so as to make them disgorge most of the blood which they have sucked, and then be put into water moderately sweetened,

In this method leeches, we are told by M. B. may not only be kept for many years, but will retain their activity, and be fit for reapplying every third or fourth day.

Dr. Scheel has more recently recommended the following treatment as still more effectual.

The leeches should first be put upon a warmish plate, and be well besprinkled with carbonate of soda; when they have disgorged most of their blood, they should be washed several times with tepid water, then put again upon a plate and some sugar sprinkled upon them; and lastly be washed with cold water and put into a large vessel full of it, gently sweetened.

The sugared water must be changed once a day, or oftener if it becomes discoloured. Those leeches which die or even become wrinkled and faded, should always be cast away.

Dr. S. has succeeded in preserving leeches thus for a great length of time, in good health, and in a condition ready for use every six or seven days.

When there is a very great dearth of leeches, the following expedient may be had recourse to. With very sharp scissors we may cut them right across, somewhat nearer the tail than the head, and then apply them as usual. As the animal sucks, the blood trickles from the divided end. As a matter of course the attendants must be on their guard to prevent an excessive discharge by detaching them at a proper time. They are then to be gently squeezed and put into fresh water. If the divided extremity should become agglutinated together and closed, we must employ a rather firmer pressure from the mouth downwards, so as to cause the blood to force an exit. Leeches which have been mutilated in the manner above mentioned, have been used several times every day for many weeks.-Allgemeine Medic. Zeitung.

INJECTIONS OF COLD WATER INTO THE UMBILICAL CORD TO PROMOTE THE SEPARATION OF THE PLACENTA.

first recommended by M. Mojon, will often succeed perfectly if it be used sufficiently early, and provided the vein does not contain too much blood; for sometimes cases occur in which it is not possible to dislodge the blood which the vein contains. One injection will frequently suffice. If we listen with the stethoscope over the region of the womb, where the placenta is attached, while a quantity of water is injected into the cord, a noise or bruit coming as if from a distance is heard; this noise is quite distinct from that of any pulsation. In favourable cases the sound becomes louder and stronger, and in addition to it other bruits of a more sibilant or whistling character become audible. Professor H. states, that he never could hear any of these last described sounds in cases in which the placenta remained obstinately attached; they would therefore seem to be connected with the contractions of the uterus. These contractions are necessarily very imperfect, when the placenta remains fixed; and hence perhaps the absence of the sounds in these cases. Professor H. recommends that the injection of the cord be used even when it does not succeed of itself, and when therefore it is necessary to remove the placenta by manual assistance; it may be a serviceable adjunct.

The most frequent cause of failure with the injections alone, is spasmodic contraction of the uterus.—Ibid.

66

This diseased state is rarely the result of inflammation, or of its consequences; but solely of the non-permeation of a portion of the pulmonary tissue by the air; the cells become more and more contracted, and finally are quite obliterated. The portions of the lungs so affected sink in water, in the same manner as hepatised or solidified lung from inflammation. One of the most common causes of this diseased state is undue quickness of the delivery. It is a fact well known to accouchers, that when a child is very rapidly ushered into the world, the first act of breathing is often delayed longer than is common, and the child appears to suffer; the circulation of the blood is consequently disturbed at the same time, and the foundation of a morbid state of the lungs is laid.

Another cause is pressure on the cerebellum, either from the immoderate contraction of the uterus, or from the forceps, when the blades are too tightly compressed a state approaching to asphyxia is thus induced, and the functions of respiration and circulation obstructed. The child is observed to be weak, and moves the limbs feebly; the limbs hang as in a palsied patient; the voice is thin and plaintive; the eyes are half opened, and the movements of the chest are indistinct, and either hurried or unusually slow. By the use of the warm bath and other means the child may be considerably revived, but the breathing remains oppressed, and each act is short, such as we observe in cases of asthma and of hydrothorax.

This description applies to those infants who are too quickly expelled: those on the other hand who are subjected to immoderate pressure usually exhibit a tumefaction of the head, a livid state of the skin, and most of the appearances of an apoplectic patient. Sometimes the breathing is not established for 15 or 20 minutes; and then it may be only imperfectly, and the child remains exceedingly weak and enfeebled. Convulsions are not unfrequent under such circumstances. When it cries the voice is puny and moaning, and the movements of the chest are at one time scarcely perceptible, and at

another heaving and irregular. The livid colour of the skin becomes less, but either does not vanish altogether, or is exchanged for an unhealthy pallidity, and there is often a cold perspiration on the surface.

The mouth and eyes are usually half open. When the disease is likely to prove fatal, the skin, from being pale, becomes suddenly blue; the child is so weak that it cannot suck, or even swallow; the voice is scarcely perceptible, the pupils are motionless, the head is drawn backwards, and a slight rattling is heard in the throat. However alarming the symptoms may seem to be, they never prove fatal on the first attack; but very generally may be mitigated by appropriate treatment, the strength becoming somewhat restored, and the convulsive or spasmodic state much lessened. Perhaps the subsequent attacks may be gradually milder, and the child almost perfectly recover; but if, on the other hand, the weakness should increase, we can have small hopes of saving the little patient. Even when it does recover, the continuance of life is always precarious; for not unfrequently a bronchitic affection, such as the "catarrhuss suffocativus," supervenes and rapidly proves fatal. The partially obstructed state of the pulmonary tissue adds greatly to the danger of such attacks. The child dies suffocated, or with all the symptoms of pressure on the brain.

Dr. Joerg is of opinion that many cases of permanent morbus cæruleus are attributable to the impediment offered to the freedom of the circulation by the obstructed state of the lungs.

We may enumerate this very generally mortal affection of the heart as a fifth mode, in which the disease of the lungs usually proves fatal; the other four being apoplexy, suffocative catarrh, bronchitis, and lastly atrophy,

Our prognosis must be in most cases unfavourable; but it will, as a matter of course, be regulated by the extent of the injury which the respiratory function appears to have sustained. Of this we may form a tolerably accurate notion by attending to the breathing of the child, and observing whether it is

ever full and deep; and also by the loudness of the voice in crying.

In endeavouring to resuscitate the child at first, great caution should be used, that the system be not over-stimulated by the means employed, for a corresponding exhaustion will inevitably succeed to such a state; and besides, if there be any encephalic congestion, the evil will be aggravated. The tartar-emetic, judiciously given, may very possibly be useful, especially when the head is free from any injury, and the affection of the lungs is, therefore, more idiopathic. The warm bath, too, will be found a good adjunct; and in cases where the infant is so weak that it cannot suck, we may immerse it in a bath of tepid milk. Artificial respiration will be necessary in some cases.-Allgemeine Medic. Zeitung.

TREATMENT OF PORRIGO.

Dr. Cazenave observes that, unless our patients be scrofulous, or otherwise cachectic, the constitutional treatment resolves itself into the mere use of an occasional purgative and of a tepid bath. An indispensable part of the local management is cleanliness. The hair must be kept closely shaved, and the scalp frequently washed with emol lient, alkaline, and sulphureous lotions, which have the good effect of separating the crusts, and cleansing all nastiness away. Dr. Biett highly praises the following formulæ.

B. Potassæ sulphuret. 3ij.
Saponis alb. 3iij.

Aquæ calcis, viij.
Spirit. vini rectif. 3ij.

fiat lotio.

And

Misce

R. Lythargyri, zij.
Aluminis usti, zjss.
Calomelanos, 3jss.
Adipis suis, bij.
Terebinth. venet. gvj. Misce.

A still more effectual remedy is the ioduret of sulphur which may be used thus

B. Ioduret. sulphur.j.-3ss.

Adipis suis, 3j. Misce.

Of this ointment, a drachm may be rubbed in each time.

The use of caustic, as of nitrate of silver, is to be recommended only when the disease is confined to one spot, or two.-Bullet. Gener. de Therap.

HEMORRHAGIC TENDENCY IN A FAMILY.

The mother was of a delicate constitution, and liable to profuse menorrhagia. She was delivered of a boy in March, 1829. It seemed torerably healthy, although fair, or almost white.

It suffered successively from jaundice, aphthæ, convulsions, and a diarrhoa, which proved fatal on the ninth day after birth. The navel-string was constantly moist with a bloody serum, which kept oozing from its divided extremity, and resisted every styptic. When the tied portion fell off, pure blood tickled from the umbilicus, which was thus always covered with a coagu lum. The scrotum, in this infant, had a dark purplish colour. Three former children of this woman died on the 8th, 12th, and the 14th days after birth, in consequence of bleeding from the navel.

The other three children of the family, although delicate, did not exhibit any hemorrhagic tendency.—Journ der Pract. Heilk.

CASES ILLUSTRATING THE TERMINATIONS OF OVARITIS PUERPERALIS. The epithet puerperal, applied to this affection, is not to be considered as indicating that it occurs only after delivery. In the 4th vol. of the "Clinique des Hôpitaux," is a report of the dissection of a woman (who never had been pregnant,) in whom the right ovary was found inflamed and much enlarged, from a purulent deposit, of a most fetid character. In another case, occurring under similar circumstances, the pus

mode its escape by the rectum, and the patient recovered.

In many of its features, ovaritis bears a strong resemblance to the abscess of the iliac fossa, the history of which has been so ably illustrated by Dupuytren, Dance, and others. At present, we shall confine our observations to the mere furnishing of cases, descriptive of the different modes in which ovaritis may terminate.

1. By Resolution. A woman, 33 years of age, was admitted into the Hôtel Dieu on the 15th day after delivery. The labour had been painful, and the child extracted by turning. The symptoms were cedema of the abdominal parietes and of the inferior extremities, suppression of the lochia, a swelling in the left iliac region, painful on touch; strangury; whitish, creamy deposit in the urine, and sense of weight in the vagina. By active local bleeding, and appropriate constitutional treatment, this woman speedily recovered.

2. By Suppuration. This is a very frequent termination. The pus makes its escape either, a, by the rectum, as in the following case.

A young woman presented a general emaciation slight effusion into the cavity of the abdomen, enlargement of the liver, a swelling, as large as a hen's egg, in the left iliac region, painful on pressure-amenorrhæa-urine containing a whitish substance, which appear

ed like pus; well-formed pus mixed with

the stools: body and neck of the uterus healthy to the touch, by which it was discovered that the tumor in the groin was connected with the womb and bladder. The patient was generally feverish, and more so towards evening. Numerous leeches were applied to the swelling, and hot fomentations afterwards. The progress of the case is not known, as she left the hospital unexpectedly. It ought, however, to be stated, that she had been delivered of a seven month child three years before her admission, after a severe, but rapid labour. Three months after this date, she began to experience pains in the hypogastrium and groins, and these had

continued with more or less severity ever since. In such cases of purulent diarrhoea, the pus may make its way either into the cæcum, the arches of the colon, or into the rectum. In the following case, it seems to have escaped into the left arch of the colon.

A woman was seized, on the second day after delivery, with all the symptoms of peritonitis; on recovering from which, she had an attack of phlegmasia dolens. While under treatment for this, a painful tumor made its appearance in the left groin. This attack of ovaritis was no sooner over, than she was again seized with peritonitis, in consequence of imprudently walking on a cold stone floor. On the 22d of March (seven weeks after her admission into the hospital), the left limb was still œdematous; and on this day was first observed purulent matter, mixed with the alvine evacuations. The great relief which the patient almost instantaneously experienced in the inguinal swelling, on the occurrence of this purulent discharge, could leave no doubt but that it proceeded from the ovary, which had very probably become adherent to the sigmoid flexure of the colon. During a space of two months the discharge ceased, and returned several times; and even when the patient left the hospital, on the 23d of June following, there still remained a degree of engorgement in the left groin, and slight oedema of the limb.

b. The pus may find an exit by the bladder of vagina. MM. Husson and Dance found that this had taken place, in a young girl who died of the dis

ease.

C. It may follow the course of the round ligament, and escape at the inguinal or crural apertures. Dupuytren has seen numerous cases of such a termination. Under these circumstances, the tumor may be mistaken for an aneurism, as it frequently pulsates, from being in close proximity to the iliac artery. In opening abscesses at this point, it is necessary to use considerable caution, as instances have been known where the artery has been inadvertently wounded.

d. It may pass into the abdominal