cavity, and either become encysted, or induce fatal peritonitis: and, e, lastly, it may be discharged at some point of the hypogastric or iliac regions (besides the inguinal aperture), in consequence of the ovary becoming adherent to the abdominal parietes, and the matter gradually working its way out. This termination is illustrated by the following case. A woman, twenty-four years of age, was delivered of her sixth child on the 17th Nov. The labour was rather painful and difficult. Imprudent exposure to cold was quickly succeeded by an attack of fever, by suppression of the lochia, and a tumefaction of the right groin. When received into the hospital, the tumor was of the size of an egg, and the limb was œdematous. In spite of repeated leechings, &c. the suppurative process commenced, and, by the end of January, several fistulous openings through the abdominal walls had taken place and from these a copious discharge of pus flowed out. The patient gradually regained her health, and left the hospital, quite cured, a few weeks afterwards. In the 4th vol. of the Bibliothêque Médicale is narrated the case of a lady, in whom two iliac abscesses, supervening upon an attack of entero-peritonitis, opened, the one into the sigmoid flexure of the colon, the other into the cœcum-and this last also projected outwardly. An incision was unfortunately made into it, and a stercoral fistula was the consequence. 3. By Ramollissement. The ovary becomes tumefied, infiltrated with a sero-purulent fluid, and either friable and easily lacerated, or extremely soft and yielding in texture. Dr. Montault saw an example of this degeneration in a young girl, who died of puerperal peritonitis. The labour had been quite natural and easy, but she had suffered much from mental anxiety, and had been exposed to cold, when she was brought to the hospital after delivery.. 4. By Enlargement and Induration. A young woman was seized with metroperitonitis, five days after her discharge from the Maternité, where she had been safely delivered. She died on the sixth day of the disease, having, on the day or two preceding her dissolution, exhibited all the symptoms of ataxic fever (from the absorption of purulent matter into the system.) On dissection, a small quantity of pus was found infiltrated into the superior and lateral portions of the uterus. The right ovary was more enlarged than the left, hardened in texture, and of a yellowish colour; firm pressure forced out only a few drops of pus. This state of induration will often continue for a long period without affecting the general health; although it must be confessed that, not unfrequently, the patient annoyed with colicky pains, proceeding from the site of the ovary, with dysmenorrhoea and other troublesome symptoms. When these are exceedingly obstinate, and progressively become more distressing, we may suspect that the enlarged and hardened viscus is degenerating into a scirrhous, lardaceous, osseous, melanotic, or hydatidic condition. Journal Hebdomadaire. CASE OF CYANOSIS, OCCURRING ON THE NINTH DAY AFTER BIRTH-CURE. The infant, when born, appeared quite healthy and strong, and indicated by its lusty cries a vigorous vitality. It exhibited not the slightest trace of any cutaneous discoloration, nor of any impediment in the breathing. The mother being unable to suckle her child, it was reared with spoon food; but in the course of a few days, symptoms of disordered stomach and bowels, announced by restlessness, fever, green stools, and griping, set in. These were for a short time relieved by carminative medicines,by rubbing the abdomen with an oily balsamic embrocation, and by camomile enemata. On the ninth day, the infant became much worse, and to the already-mentioned disorders were added convulsions, and an unexpected invasion of "morbus cæruleus" over the whole surface of the body and limbs. Every part, including even the tongue and nails, were stained of a deep blue colour. The tender patient seemed to suffer much distress, as it kept constantly moaning most piteously, and drawing its limbs convulsively together. The temperature of the surface was somewhat lower than in health-the pulse was small and contracted, but not quickened-the breathing was short, feeble and irregular, deep at one moment, and hurried the next. Whatever opinion might be formed of the proximate cause of the purple colour, it could not be overlooked that its invasion had been preceded and accompanied by a convulsive state of the system, arising from severe colic: moreover, it could not reasonably be attributed to any transitory retardation of, or obstruction to, the course of the blood, else it must have speedily passed away; and we were, therefore, obliged to suspect that, in consequence of the pulmonary circulation being disturbed, and thus occasioning an excessive accummulation of blood in the right cavities of the heart, during the recurrence of the repeated spasms, either the foramen ovale or the ductus arteriosus had been forced open, and allowed the admixture of the venous with the arterial blood. The prognosis was, therefore, most unfavourable; and the indications of treatment were, to correct the disordered state of the bowels, and to allay the general distress. For this purpose, a tea-spoonful of the following mixture was ordered to be given very frequently: B. Magnes. carbon. 3j. An occasional warm bath and assafœtida enemas were also prescribed. Little good was derived from these remedies, and, as the child evidently began to be weaker and more exhausted, a nervous powder, containing one grain of musk, was given every hour or two. This treatment was continued for two days (so that 26 grains of the musk were taken in this period,) with manifest advantage; the heat of the body became greater, the circulation and breathing less disturbed, and the child more lively and comfortable-the blue colour, however, was unabated. But, even in this symptom, a favorable change soon began to be perceived. The musk was persevered in, one grain being given every three or four hours, and a tea-spoonful of the magnesia and rhubarb carminative occasionally. An aromatic bath was also used twice a day. The case went on progressively to a complete cure; the blueness of the skin gradually subsided, and altogether disappeared about the 12th day from its invasion.-Journ. der Pract. Heilk. ON THE EXTERNAL USE OF CROTON OIL. This valuable drug was first made known to the profession by Dr. Connwell, in 1820, and subsequently its therapeutic effects were investigated by MM. Recamier, Bally, and Majendie; their researches were, however limited to its internal exhibition, and it was not until 1831 and 1832 that its great value, as a counter-irritant to the skin, was clearly proved by Professor Andral. External Use. With one or two fingers, or, if we choose, with a dossil of lint, wetted with the oil, we continue rubbing the skin for the space of about 10 minutes. This operation should never be entrusted to the patient him self-in two cases at the Hôpital de la Pitié, we observed violent ophthalmia and inflammation of the penis and scrotum induced, no doubt in consequence of the mere inadvertently carrying their fingers to their eyes and genital organs. The eruption, which is brought out by the external use of the croton oil, may be divided into five stages: 1, Rubefaction of the skin-2, Formation of vesicles-3, Conversion of the vesicles into pustules-4, Desiccation of the pustules-5, Desquamation and falling off of the crusts. These different periods or stages are not uniformly to be observed; they are most conspicuous when the friction has been made with ten or twelve drops of the oil, on a part of the skin where there is much subjacent cellular tissue. The patient at first experiences a tingling warmth, which is quickly followed by a considerable redness, extending an inch or so beyond the sphere of the rubbing. These appearances are generally noticed within 7 or 8 hours, sometimes in 1 or 2, at other times not for 10 or 12 hours; the differences of time required depending, no doubt, on the delicacy of the skin. In from 14 to 26 hours, myriads of small, close-set vesicles make their appearance upon the inflamed skin. Occasionally, a few of the vesicles become greatly magnified, forming true phlyctenæ, filled with a turbid lymph, which speedily change into a purulent matter. In 12 out of 31 cases, reported by our author, the vesicles passed to desquamation without undergoing the suppurative process. The usual period at which the serum becomes puriform, is from 36 to 54 hours after the application of the oil. In one or two days subsequently, the pus begins to exude, and forms greyish crusts over the pustules, and the desquamation is generally over by the 8th or 9th day. If the croton oil is rubbed upon any part which has been recently vesicated, the eruption is, as we might expect, more speedy and abundant. In six cases, it was tried whether the rubbing in of the croton oil, mixed with an equal quantity, or with rather more, of that of almond oil, over the arch of the colon, would produce any purgative effects; an eruption, which reached the second stage, was brought out, but the action of the bowels was not affected. Similar results were obtained when the pure oil, to the amount of 20 drops, was rubbed round the umbilicus. Dr. Rayer states that he has repeatedly induced free action of the bowels, by putting two or three drops of the oil upon a surface, denuded of its epidermis by a blister. We have not repeated this experiment. Therapeutic Effects. The diseases in which the external use of this remedy has been employed with most advantage, are chronic rheumatism, arthritic pains, pleurodynia, paralysis, stomatite, laryngitis, and chronic gastritis. CASE 1.- Sciatica. A man, aged 48, was admitted into the Hôpital de la Pitié on the 6th Dec. 1831. For five months preceding, he had suffered severely from pain, beginning in his right hip, and extending down the back of the limb, along the course of the sciatic nerve to the outside of the leg. For two months and a half he was obliged to keep the house, and, upon then attempting to resume his work, the pain returned with all its former intensity. He attributed his complaints to exposure to wet and cold. The only treatment which had been followed before his admission was blistering the limb; but he had derived no benefit. When examined in the hospital, the pain was found to be increased by pressure, and by the heat of the bed; he complained of headach, but in other respects his general health was not amiss. Eight drops of croton oil were ordered to be rubbed in over the origin of the sciatic nerve. This produced considerable itching and redness, but no vesicles; and, the pain being not relieved, 18 drops of the oil were rubbed along the whole trajet of the affected nerve. Next morning, the outer side of the leg was much reddened, and vesicles had formed over the trochanters. On the 11th, ten drops more were rubbed in between the trochanters.-12th, The eruption considerable-some large papulæ had appeared over the fibula. The neuralgic pain almost gone-only the heat and itchiness of the eruption are troublesome. He left the hospital in a few days, quite well. CASE 2.-Sciatica. A man, aged 50, entered the La Pitié Hospital in Dec. 1831, suffering from sciatica of six weeks' standing. Twelve drops of cro ton oil were well rubbed in between the trochanters, along the outside of the thigh, to the lower third of the leg; a copious eruption was induced, and already, upon the second day, the patient felt relieved. In six days more he was considered cured, and left the hospital, quite delighted with the rapidity of his cure. He had experienced two severe attacks before-once in 1812, when he was treated in the Hôtel Dieu by M. Recamier, with the essence of turpentine at that time he was six weeks in the hospital; and again, two years ago, after exposure to wet and fatigue, he was admitted into the Hôpital de la Charité, under the care of M. Fouquier, who employed blisters and friction, with anodyne balsam. He was cured then in three weeks. CASE 3.- Sciatica. A stout, plethoric man, 45 years of age, had, for about a month, felt general indisposition, frequently-returning shiverings, and neuralgic pain of the left extremity. He was taken into the La Charité Hospital, and there treated by M. Rayer with repeated venesection, the application of 50 leeches to the hip, and 40 more to the back of the thigh. The essence of turpentine was administered inwardly in frequent doses; and besides all this, the vapour-bath was used fourteen times. This treatment was continued for three weeks, and, as little benefit had been obtained, the patient left the hospital, and a few days subsequently entered the La Pitié. At that time, the pain extended from the ischium down to the ankle-joint, and it was increased by walking, and by the heat of the bed: the lower part of the leg was annoyed with a feeling of formication. The digestive organs were in good order. Fifteen drops of croton oil were rubbed in over the origin of the sciatic nerve. On the following day, 20 drops more were rubbed over the tract of the affected nerve; a vesicular eruption made its appearance, and the neuralgic pain was already diminished. On the 29th (3d day,) twenty drops were again ordered. 30th. The eruption is very abundant-the vesicles have changed into large pustules. The patient complains only of the itching; the pain is gone. He remained a few days longer in the hospital, until the crusts separated; and, on the 12th day after his admission, he was discharged cured. A case of chronic rheumatism of the shoulder-joint, supervening on typhus fever, is given, in which general and local bleeding, blisters, &c. had been fruitlessly used for the space of six weeks. The friction with a few drops of croton oil was employed twice; and on the third day the patient could move his arm-although not entirely cured, he was very much relieved, when he left the hospital. CASE 4.-Anesthesia, or Paralysis of Feeling. Pierre Dumas was admitted into the Hôpital de la Pitié on the 9th Nov. 1831. Seven months before he had an attack of erysipelas of the face, and the inflammation had extended down the left side of the neck. Three weeks after his recovery from this illness, he was suddenly seized with dimness of sight and stunning noises in his ear; these symptoms were not constant, but came and went, returning every 2d or 3rd day. This state of things lasted for about two months, during which nothing had been done in the way of medical treatment; and then there supervened a general numbness of the whole left side of the face, and the sight of the left eye became affected at the same time-the left nostril lost the sense of smell, and the left side of the mouth its sense of taste. When he was shaving, he felt as if some foreign body was placed upon his cheek; and, in chewing, the food seemed like earth in his mouth. He complained of a very severe frontal cephalalgia-the tongue was loaded, the abdomen soft, the bowels rather relaxed, pulse 90, breathing not affected. He was ordered to be largely bled from the arm-to use a mustard-bath to his feet at night, and to be put on a light emollient diet. 10th. No relief; half a drop of croton oil in two pills at bed time. 11th. Twenty liquid stools from the pills; headach much better; paralysis not affected. Eight drops of the oil to be rubbed upon the left cheek and side of the neck. On the following day the skin was well reddened, and a large crop of confluent vesicles had made their appearance to our great surprise he had already recovered his sight, taste, smell and feeling. The fifth period of the eruption, or that of desquamation, was not over until the thirteenth day. He did not leave the hospital till the 12th December, having had a threatening of a relapse of the numbness in a slight degree; but this was checked by a bleeding from the foot. CASE 5. Angina Laryngea-Aphonia. -An itinerant singer of the streets of Paris, presented, upon his admission, the following symptoms; a frequent dry and harsh cough: pain over the larynx, increased by swallowing; breathing sibilant; voice almost entirely gone, so that he could not make himself understood. Upon examining his throat, the velum and its pillars were observed red and swollen. Venesection, a sinapised foot-bath and emollient drinks ordered. The following day he was much better; the general symptoms were relieved; but the aphonia was as complete as before. Ten drops of croton oil to be rubbed on the front of the neck. In 24 hours there was a copious confluent eruption; the voice was regained, and the deglutition more easy. He left the hospital three days afterwards quite cured. CASE 6. Diptherite, or Stomatitis pseudo-membranacea. An old soldier, upwards of 60 years of age, exhibited a specimen of this disease to our notice in the Hôpital de la Pitié. It had already existed for eight days, and had made considerable progress; the inside of the mouth and the surface of the tongue being covered every here and there with small oblong crusts, or laminæ of a greyish-white colour, set upon red, inflamed, and swollen bases; the submaxillary glands were painful and enlarged; the breath excessively foetid, the lips swelled and of a purple hue; and the deglutition very difficult. Sixty leeches had been applied at two different times behind the jaws; and poultices and a multitude of gargles had been used without much good for the poor patient, who could scarcely articulate a word. Eight drops of croton oil were ordered to be rubbed in upon the sides of the neck. On the morrow a copious eruption of vesicles had appeared, and considerable relief was already experienced. From this period the disease appeared to have undergone a favourable change, and in fifteen days more, under the use of acid gargles and of poultices, it was altogether removed. CAUSES OF THE SHORTENING OF THE LIMB IN MORBUS COXARIUS. M. Dzondi, in a remarkably perspicuous essay on this disease, observes, that the shortening of the limb which takes place in the third stage of hip-joint disease, is not attributable solely and on all occasions to the actual dislocation of the head of the bone from its cotyloid cavity. It may be produced, to a certain extent, by other causes. Among these he enumerates 1. Sympathetic irritation of the cervix femoris, occasioning an alteration in its direction; so that the angle forming between it and the shaft of the bone becomes more acute. 2. The extenuation or destruction of the articular cartilages and of the synovial membranes. 3. The irregularity and unevenness of surface which the head of the bone and the acetabulum acquire, and which prevent their accurate contact. 4. The os femoris itself undergoing a certain change, and becoming somewhat shorter. 5. The perforation of the fundus of the acetabulum, and the protrusion of the ball of the former through it. In an earlier part of the essay M. Dzondi has most accurately described the symptoms of the three successive stages, viz. the inflammatory, the purulent, and lastly the third, when the pus extends and becomes diffused in different directions; sometimes causing description of the capsular ligament, |