of Surgery for severe inflammation of the left eye, affecting several of the structures. Cupped to twenty ounces, and two grains of calomel, with some rhubarb and antimonial powder, to be taken every three hours. 2nd day, cupped to the same quantity, and the pills to be continued. 3d day, bled, at twice, to the amount of forty-five ounces, and ordered three grains of calomel, with one of opium. 4th day, bled ad deliquium. Same dose of calomel and opium. 5th day, bled again. 6th day, bled to 16 ounces. 7th day, bled and purged. The pain and inflammation now subdued.

This is a miraculous cure, and worthy of being recorded. But it is just as possible that some effusion of blood might have been spared, and the cure have been quite as speedy, had some auxiliaries been added to the LANCET, (which is the staff of life in Panton Square) in the shape of antimony, colchicum, and some other antiphlogistics. As the deep-seated textures of the eye were, apparently, implicated, some people would have given the calomel and opium in a more efficient manner, and affected the mouth in a couple of days, by which the inflammation would have been arrested. It is true, that the man is turned out of hands cured of the ophthalmia-but the lancet may, perchance, have laid the foundation of a job for the doctors bye and bye.

42. CASE OF CHRONIC DYSPNŒA.

The younger Andral, whose name is familiar to our readers, has related a curious case of this kind, which is worthy of notice.

Case. A young man, with glandular swellings on both sides of the neck, presented, for some time, certain symptoms of organic disease of the heart, and entered La Charité in March, 1826. His face was puffy, livid, and the eye-lids œedematous-belly dropsical-breathing short and quick, and performed entirely by the action of the ribs on each side-inability to lie down without sense of suffocation. This state of dyspnoea had continued for more than a year, and was always augmented by wet weather. The chest sounded well in every part, and auscultation could detect nothing particular in the region of the heart. A mucous wheeze was heard in various points of the thorax, with some cough, and a trifling mucous expectoration. The appetite was good, and the bowels rather relaxed, but without any abdominal pain. The pulse was natural in every respect. There were, therefore, no proofs, by auscultation, of any organic disease of the heart, although many general symptoms seemed to indicate the existence of such a lesion. There was something particular, however, in the dropsical effusion. It was confined to the abdomen, which is seldom the case in disease of the central organ of the circulation. Various therapeutical agents were employed, as local and general bleeding, blisters, diuretics, &c. During the succeeding six weeks there was no perceptible alteration. The orthopuca was constant, and the patient was breathless whenever he attempted to get out of bed. Auscultation was repeatedly tried, but without any conclusive results. He was suddenly seized, on the 1st of May, with an augmentation of the dyspnoea, which soon became extreme, and in a few hours he died, apparently suffocated.

Dissection. No visible alteration in the brain or spinal marrow. The heart was found perfect in every respect, as were the large vessels issuing from the heart. There were a few miliary tubercles distributed here and there in the lungs, which were otherwise sound and crepitous. The anterior mediastinum contained a mass of tuberculated lymphatic glands, through the centre of which passed the two phrenic nerves, which could not be disentangled from it, and by which they were compressed. From the exit of these nerves

to their distribution on the diaphragm, they were remarkable by their grey colour, resembling that of the optic nerves in a state of great atrophy. There was no abdominal lesion of any consequence, except the serous effusion above-mentioned, and another mass of tuberculated glands in front of the vertebral column, which pressed strongly on the cava inferior, and also the vena portæ, which they completely encircled. On each side of the neck, from the angle of the jaw to the clavicle, there was a chain of tuberculated lym phatics, several of which were interposed between the vessels and nerves of the neck. The carotid artery and jugular vein were separated to some distance by these enlarged glands. The pneumo-gastric nerves, on both sides, were entangled in these masses, and remarkably flattened at these points. There was nothing else remarkable in the body.

Remarks. It is impossible not to accord with M. Andral, in placing the terrible dyspnoea and orthopnoea, in this case, to the pressure on the pneumo-gastric and phrenic nerves-in the absence of organic disease of the heart. Perhaps, Dr. Paris may be inclined to take advantage of this case for the support of some pathological opinions which he has broached in his work on diet, and which are noticed towards the close of our review of his work in this Number of our Journal. He is at perfect liberty. But we would beg him to remember that, in his case, there was aneurism of the heart, and no mechanical pressure on the phrenic or diaphragmatic nerves -whereas, in the present case, there was mechanical pressure on the nerves, and no disease of the heart. This makes some little difference. Moreover, in Dr. Paris's case, there was swelling of the limbs as well as of the body, the common consequence of disease of the heart-whereas, in Andral's case, the effusion was confined to the abdomen, and may fairly be attributed to the pressure on the cava and vena portæ.

We have marked this last circumstance in Italics, because it bears on another physiological opinion common to Dr. Paris and Dr. Yeats-namely, that the pressure of a distended duodenum on the cava, caused weakness and fluttering of the pulse. Here there was anatomical evidence of mecha. nical pressure on the cava, and yet it is distinctly stated by Andral, who could have no theory to support by such statement, that the pulse was always perfectly natural.-Biblioth. Med. Juill. 1826.

43. EMPYEMA.

A young man was received into Guy's Hospital, in August last, presenting a remarkable enlargement of the left side of the thorax, and a tumour the size of an orange situated between the edges of the false ribs and crista of the ilium. The man's history shewed successive attacks of thoracic inflammation, attended by the usual symptoms; and at one time he could plainly hear the squashing of a fluid in the left side of his chest. On pressing the tumour, its contents could be squeezed back. It was punctured, and 20 ounces of pus evacuated. After this, repeated evacuations took place from the tumour, and in the course of sixteen days 206 ounces were drawn off. But the cough became more harrassing-fever came on-the expectoration became purulent, and the patient died in less than a month from the operation.

The left side of the thorax was found filled with air and some remains of the fluid-lungs shrivelled up-pleura coated on all sides with a thick false membrane An elongation of the pleural sac had taken place between the 11th and 12th ribs, forming the tumour above-mentioned. In the right lung too small vomicæ were found.-LANCET.

The size of the left side of the thorax shewed evidence of such a large quantity of fluid, that little could have been expected from its evacuation, as, in such cases, the lung of that side is generally annihilated, and it is impossible that the other lung can be dilated so as to fill up both sides of the chest-in default of which, air must get in and supply the vacuum. Still the medical officer was perfectly justifiable in giving paracentesis a trial.

We saw a man lately from a distant part of the country, who could, by a particular succussion of his chest, produce the distinct noise of water squashing about in the cavity of the pleura. There was no respiratory noise in the right side of the chest, except very high up, and that not clear. He had this complaint for several years, and was otherwise in tolerable good health. The disease seemed to be at a stand-neither increasing nor decreasing.

44. SPECTRAL ILLUSIONS; OR THE INFLUENCE OF THE DIGESTIVE ORGANS ON MR. ABERNETHY'S OPTICS.

When we heard an ejaculation of joy in the Radical Press, at delivery from an INCUBUS, we gave up all hopes of ever deriving amusement or instruction from the facetic of Mr. Abernethy again. We have been most agreeably deceived; and are happy to find YORICK once more on the tapis, "setting the table in a roar," with his lively jokes and witticisms. Whether the present series of "Tales of my Landlord," be meant to ridicule the Lecturer, amuse the public, or eke out a subject that is growing somewhat scarce, like subjects of another kind, we cannot say. But be this as it may, the lectures, as they now appear, are very curious articles, in which quaint truisms are mingled with laughable observations, and just practical rules. We shall only allude in this place to a spectral illusion of a rather extraordinary nature, with which Mr. Abernethy is troubled.

We are informed that the head of Mr. Abernethy's horse came one day in contact with his own, by which accident he had his nose broken, and, for some time afterwards, could only see "two thirds of an object." But even in this case, we are disposed to think the worthy lecturer's optic nerves were more accommodating than his auditory-for, to this day, the latter will not listen to more than one third of a story-unless, indeed, the story be his own. Thús, in looking up at his own name in a shop-window,

A-BER-NE-THY,

he could only see as far as the NE (knee) for the THY (thigh) was quite out of the field of vision, (a laugh.) What witty dogs are these nightmares, or rather their exhibitors!

Mr. A. has occasionally, some curious "errors of action, or inactivity in parts of the retina," resulting, we should imagine, from his " digestive organs." He can, when looking in a glass, see the upper part of his head, but he never saw (says he,) that he had any mouth or jaw"-all being blank between the nose and shoulders. We are most happy to think that these are only spectral illusions, and hope the worthy lecturer will long continue to convince the world, that he has a mouth of his own to tell his pupils so many droll stories, and a MOUTH-PIECE in some reporter to retail them to the public at large.

We understand that a still more curious illusion occurs when Mr. Abernethy looks at a patient-for then he can see nothing but the tongue-all the rest of the patient's body being a blank.—Rev.

45. ERGOT OF RYE IN UTERINE HÆMORRHAGE.

M. Goupil, after relating a case where the secale cornutum hastened delivery, proceeds to the statement of another case where it apparently tended to arrest a uterine hæmorrhage.

Case. Madame F. the mother of three children, was delivered of a fourth, after half an hour's expulsive pains. The placenta was removed by a midwife, and, according to her own account, without any force. A profuse hæmorrhage succeeded, and M. Goupil was summoned. Cold applications, and the introduction of the hand into the uterus failed to arrest the flow of blood; and, in this predicament, our author administered twelve grains of the ergot. In ten minutes there was a powerful and painful contraction of the uterus. The hæmorrhage was arrested, and did not return; but a second dose was administered, by way of precaution.

We much wonder, after the evidence which has been afforded, of late years, respecting the power of this substance over contraction of the uterine fibres, that it has not been frequently tried in uterine hæmorrhage.-Biblioth. Juillet.

46. VESICAL FISTULA.

In No. 167 of the Lancet, a case of this kind is related, on which we have a remark to make. The patient was originally under Mr. Burrows, an intelligent surgeon in Holborn, for a swelling just below the umbilicus, which terminated in suppuration, and was opened by Mr. Stanley. Ilconditioned pus was first discharged, and soon afterwards urine came through the opening. This discharge had continued about two years, when he was received into Guy's Hospital. "When the patient strains, or calls the abdominal muscles into action, a fluid is discharged from the opening, which is undoubtedly urine. A small quantity of urine only is discharged in the natural way." Sir Astley Cooper examined the case in Guy's, and concluded very justly that there was a fistulous communication between the abdominal aperture and the bladder. But the reporter puts an expression into Sir Astley's mouth which we are convinced that distinguished surgeon never uttered, namely that-" it was almost inexplicable that the urine which was discharged into the bladder, at a considerable distance below the fistulous opening, should, as it were, ascend against its own gravity, and be expelled from the aperture."

If the reporter were well acquainted with the laws of physics or physiology, he would be aware that there never is any cavity in the bladder, the patietes of that organ being always n contact with their contents (allowing for the ruga) whether there be a spoonful or a quart of urine in the bladder. The fistulous aperture, therefore, supposing it to be in the very fundus of the bladder, is always in communication with the urine; and, as there is no sphincter to be overcome there, when the abdominal muscles are thrown into action, where is the wonder that the urine should issue from the external aperture?—qua data porta ruit. The patient is in the same condition as a man whose bladder is punctured above the pubes, and a tube left in the wound. In such case, the water is always dribbling through the canula as it is secreted, unless the tube be kept corked. We knew a gentleman who passed all his urine in this manner for two years or more, and, after all, the urine came through its natural channel ultimately, and the artificial opening above the pubes healed. The man in Guy's Hospital should have a catheter kept in the bladder, and pressure made on the fistulous opening in the abdomen. This would give him a very probable chance of cure.-Chirurgus. VOL VI. No. 11.

S

47. EXCISION OF PART OF THE MAXILLA INFERIOR, Mr. Lizars, of Edinburgh, has lately added another wreath of laurel to his brows, by the operation above-mentioned. The patient was a robust man, 38 years of age, who had been operated on, two years previously, for cancer of the upper lip. Several months afterwards, a lymphatic gland at the base of the inferior maxilla enlarged and became adherent to the bone. This had lately become rounder, conical, the size of an orange, so as to completely lock the two jaws. In short, the disease was pronounced to be osteosarcoma, and considered by Mr. L. as incurable, except by the entire removal of the diseased bone. The operation was performed on the 16th August, in the presence of Dr. Scott, of Cupar, Dr. Duncan, Dr. Poole, Dr. Borthwick, &c. The steps of the operation are minutely detailed in the October Number of the Edinburgh Journal, and do great credit to the operator. In the early stage of the operation, a multiplicity of arteries sprang, and required the ligature. Mr. L. then proceeded to remove the bone, first rendering it rudely clean at the symphysis, where the disease had extended so far as to involve the four incisor teeth. He attempted to snap the bone with Mr. Liston's nippers, but was foiled, and obliged to saw it through. He next detached it by sweeping with the scalpel, its cutting edge kept towards the chin and trachea. The lingual artery with some others sprang at this time, but the bone being removed, they were easily secured. Mr. L. carefully examined the surface of this extensive wound, removing every apparent vestige of disease. The wound was then sponged, the lips approximated, and proper dressings applied. The operation was rendered exceedingly complicated and difficult by first attempting to remove the tumour and preserve the bone. This was found impracticable, because a part of the tumour was formed by the bone itself, and incapable of being detached from it.

The symptoms which succeeded this formidable operation were not more severe than might reasonably have been expected, and the recovery may be said to be complete. The patient can swallow any pulpy mass-the gap is exceedingly small, about the twelfth of an inch in breadth, and one inch in length. He feels no pain in any part of the wound, and both the cut ends of the bone are covered with granulations. He sits out of bed, and could walk about the room, at the date of report.

The operation is exceedingly creditable to the intrepidity and dexterity of this accomplished surgeon.

In a late sitting of the Parisian Academy, M. Dupuytren presented three patients on whom he had performed the operation in question. This talented surgeon, when on a visit to the Hospital of Invalids 14 years ago, observed that some of the soldiers had had portions of the lower jaw carried away by gun-shot wounds, and yet survived the accident. He, therefore, determined to perform this operation in cases where tumours were adherent to the bone, and incapable of being removed otherwise. In the case of one of the patients now presented, he divided the jaw bone at the symphysis, and amputated a large portion of the bone, including several molares. The soft parts were brought together, the ends of the bone approximated gradually, and, in twenty-five days, the man (who was a hackney-coach master) was able to resume his occupations. M. Dupuytren has now performed this operation seventeen times, fifteen of which proved successful.

48. ORTHOPEDIA.

A female had her leg fractured, and being badly attended, in a chirur gical point of view, the limb, at the end of four months, was so crooked