uterus to contract upon the fœtus before efficient labour could take place,— the patient having been subject to convulsions in her former labours.

Of the two still-born children, one was delivered by the forceps and the other by the crotchet. The mother, in the forceps' case, recovered rapidly from a short attack of peritonitis; and the subject of the crotchet delivery experienced no inconvenience from a protracted labour except an attack of the then prevailing disease (fever), from which she recovered under ordinary treatment of cups to the head and repeated purgatives.

Twenty-four cases of the first position of the vertex, three of the second, one of the fourth, which became spontaneously connected with the first, and one case of knee-presentation, were recognised; in the other cases delivery was too far advanced to make it an object to determine the position.

Twelve pupils have been in attendance upon Dr. Warrington's course of practical instructions in obstetrics at the Philadelphia Dispensary; each of these has had the opportunity of attending from three to four cases, either in conjunction with the accoucheur, or has had them placed under his own care, calling in the aid of the accoucheur whenever he deemed it necessary. These instructions, we learn, will be resumed in the first week of September, and continued twice each week for four weeks.

Luxation of the Thigh, dating seven months and a half; attempt at reduction; fracture of the bone during the operation.'-An opinion generally prevails amongst surgeons that no attempt should be made at reducing a luxated limb, when two or three months have elapsed since the receipt of the accident. It is, however, certain, that luxations of a much more ancient date have been reduced, and pathological anatomy shows that in some cases of dislocation of long standing we may attempt reduction with considerable hope of success. Thus, for example, the head of the bone may have been forced through a simple laceration of the fibrous capsule; here, the articulating extremity of the bone, although displaced, is still connected with the capsule, which continues to secrete synovia, and does not become completely disorganised. The reduction of old luxations requires the employment of very considerable force, and accidents sometimes occur even when the mechanical means resorted to have been directed by skilful surgeons. An accident of this kind lately befel M. Malgaigne, at the Hospital of La Charité.

A lad, seventeen years of age, was admitted into the hospital with incomplete luxation of the thigh, upwards and outwards, which dated seven months and a half; the injured limb was not much deformed, but there existed a distance of half an inch between the head of the bone and the cotyloid cavity. For several days weights, gradually varying from ten to thirteen, twenty-four, and forty-five kilog., were attached to the extremity of the injured limb, for the purpose of extending or breaking any cellular bands which might retain the head of the bone in its abnormal position. Two thirds of the distance between the head of the bone and its cavity had been thus accomplished, when more powerful means were had recourse to. A lever was firmly attached to the outer side of the thigh, and the extending force carried to an equivalent of two hundred kilog., but afterwards reduced to one hundred and forty; the head of the femur was now brought down on a level with the acetabulum, the extending force suspended, and the two assistants having bent the leg on the thigh, were directed to rotate the latter from without inwards; during this manœuvre the femur was broken across at its lower third.-French Lancet, Feb. 3, 1838.

1 Lancet for March 3, 1838, p. 835.

2 The kilogramme weighs about two pounds five grains.

Wound of the Ascending Arch of the Aorta. Spontaneous Cure.-The following remarkable case shows to what an extent the curative powers of nature may occasionally be carried :

J. H., 32 years of age, a strong robust soldier of the Bavarian army, received, in 1812, a stab of a knife, which penetrated the chest between the fifth and sixth ribs. The man fell to the earth without consciousness, and remained there for more than an hour exposed to extreme cold. In this situation he was discovered by Dr. Neil, of Bramberg, who, although the patient seemed on the point of death, thought it right to bring the edges of the wound together, and had the man conveyed to the hospital. At the expiration of two or three hours, the hemorrhage continuing abundantly, the man came to himself but could distinguish nothing; he was affected with an incurable amaurosis. After a few weeks the wound healed completely; the man now left the hospital, and to console himself for his infirmity gave himself up to drink, which at length, in 1813, brought on a fatal pneumonia. On examining the body it was found that the wound traversed the lungs completely across, the entrance and exit of the knife being marked by cicatrices; at the level of one of the cicatrices a solution of continuity was discovered in the ascending aorta; it was about a quarter of a line in length, and closed with firm fibrine. The artery was now removed with caution, and divided internally, when a small cicatrix, corresponding with the external lesion, was discovered in the inner parietes of the vessel, thus, showing that the three coats of the artery had been divided by the instrument.1

BOOKS RECEIVED.

Annual Announcement of the Jefferson Medical College, for the session of 1837-8. 8vo, pp. 16. Philadelphia, 1838.

From Prof. Cabell.-Catalogue of the Officers and Students of the University of Virginia, session 1837-8. 8vo, pp. 24. Charlottesville, 1838. From Prof. Charles Davis.-Address to the Graduates of the Medical College of Georgia, delivered April 2, 1838. By the Rev. Elijah Sinclair, one of the Board of Trustees. (Published by order of the Board of Trustees.) 8vo, pp. 11. Augusta, 1838.

[For a notice of this address see a former number of the "Intelligencer."] From the same. Report of the Board of Health-Return of Deaths within the city of Charleston from Jan. 1, 1837, to Jan. 1, 1838; with an abstract of the weather for the year 1837.

From J. J. Smith, Jr., Esq.-First Supplement to the large Catalogue of Books belonging to the Library Company of Philadelphia, including the importation of May, 1838. 8vo, pp. 45. Philadelphia, 1838.

Manuel complet de Clinique Médicale et Chirurgicale, et de l'art des Accouchements; par des Professeurs agrégés et des Docteurs de la Faculté de Paris; publié sons la direction de P. Vavasseur, D. M., Edit. Belge, augmentée d'une planche d'instruments nouveaux de Chirurgie, et du formulaire magistral Français et Latin de J. L, Alibert. 12mo, pp. 612. Bruxelles, 1836.

Manuel pratique d'Orthopédie, ou Traité élémentaire sur les Moyens de prévenir et de guerir toutes les difformités du corps humain: par F. L. E. Mellet, Docteur en Chirurgie de la Faculté de Paris, &c.; avec 18 planches. 12mo, pp. 330. Bruxelles, 1836.

Précis analytique et raisonné du système de Lavater sur les signes physiognomiques, &c. &c.; par N. J. Ottin, Ancien Professeur et Pensionnaire de l'Université. 12mo, pp. 444: avec 23 planches. Bruxelles, 1834.

1 Arch. Général., May 1838, and Lancet, June 9, 1838, p. 383.

THE

AMERICAN MEDICAL INTELLIGENCER.

Vol. II.

August 15, 1838.

No. 10.

ART. I.-CASE OF IMPETIGO SPARSA, CURED BY THE SULPHUR FUMIGATING BATHS.1

In requesting your publication of the accompanying case, I do not seek to excite the interest of your readers by any anomaly in the symptoms. My sole object is, an attempt to increase the notoriety of a remedy which has acted specifically in a class of diseases, I will venture to say, amongst the most intractable ever submitted to the treatment of medical practitioners.

A gentleman, 47 years of age, of a remarkably healthy constitution, and temperate in his habits, has had for the last seven or eight years a very troublesome cutaneous eruption on the legs, but much more severe on the right extremity. An inveterate itching, commencing on the inner surface of the right ankle, was soon succeeded by an intensely bright red diffusive inflammation. With these symptoms, crops of small vesicles broke out, pouring out copiously a perfectly limpid fluid. The pruritus and inflammation speedily extended over a larger surface of the leg, and the oozing from the vesicles became extremely annoying, by stiffening and agglutinating the dressings. The vesicles having evacuated their fluid, assumed the appearance of thin laminated scales of a brownish colour, and were easily removed by the finger. The disorder was doubtless much aggravated by the irresistible habit of scratching with the nails. In no period of the complaint was there any evidence of derangement of the bowels or constitutional disorder. During this stage the symptoms corresponded with the eczema rubrum of Willan, or the dartre squameuse humide of Alibert, Rayer, &c.; the only difference being that the eczema or dartre very frequently spreads over a large surface of the trunk of the body, whereas the disease in question evinced in no stage of its existence any disposition to climb higher than the knee. To go into minute detail as to the treatment would be superfluous. It must be candidly confessed that the complaint obstinately resisted all the remedies usually adopted. Cooling astringent lotions, warm fomentations, escharotics, mild and stimulating unguents-each had its fair trial, none of them did good, and some produced positive mischief. The only application affording any thing like tolerable comfort were pledgets of linen rag steeped in cold water. The eruption had now taken up a firm position for upwards of seven years, and the patient began to abandon himself to despair, when a striking change took place in the character of the eruptive symptoms. The eruption having hitherto been vesicular, gradually put on a pustular appearance, but no mitigation of the pruritus, nor indeed any perceptible diminution of oozing, although the fluid, instead of being limpid, became purulent.

A consultation was now held with Dr. Green, and he decided in naming the disease impetigo sparsa. The pustules were, if possible, the cause of 1 London Medical Gazette, June 16, 1838, p. 500.

VOL. II.-10

more violent itching than the vesicles, and various superficial small ulcers appeared, probably occasioned by the uncontrollable habit of scratching. The eruption had now occupied the whole surface of the right leg. An ointment composed of unguent. plumbi superacet. 3 ii., with an equal quantity of prepared chalk stirred in while the ointment was in a melted state, produced a cleansing effect, by causing an absorption of the fluid.1

to.

After much persuasion the patient now consented to make trial of the sulphur fumigating baths; and here the purport of this communication discloses itself, in the complete and permanent cure effected by this powerful remedy. It was after the third bath that a decided improvement in the aspéct of the leg occurred. By a steady continuation of about three baths per week, a disease of upwards of seven years' standing has, in the course of five weeks, entirely yielded, and the appearance of the skin is now, perhaps, more healthy than it was before the discoloration began. When I add, that scarcely any internal medicines were employed, it is but justice to award the whole merit of the cure to the external remedy. It is true that the blue pill and the liquor arsenicalis were had recourse to for a time, but a slight affection of the bowels occurring a short time after commencing those medicines, they were abandoned, and have never since been renewed. The unequivocal success attendant upon the use of these baths, induces me to offer a few remarks upon a remedy not, I fear, by any means so generally known, at least not so deservedly appreciated as its merits lay claim And it will afford me much satisfaction if the above case, supported as it is by a multitude of others successfully treated by this simple but powerful agent, should be the means of convincing those numerous readers of the Medical Gazette, who may have patient's tormented with cutaneous disease under any form, that they have a remedy—I do not hesitate to say a specific -at hand. And allow me to support this assertion by referring to what is doing, and has for some years been doing, in France and Germany, in regard to these troublesome disorders, hitherto in England ranked among the opprobia medicorum. In France, when any important discovery or invention in medicine gains popularity, it immediately attracts the attention of the government, and every facility is afforded in an investigation as to its merits; so that every resource which science can command is put in action to establish the efficacy or inutility of the invention. The result of the thorough investigation as to the alleged curative powers of the sulphur fumigating baths has thus been most satisfactory. In order to form a just decision, the French government directed reports to be drawn up by the most eminent practitioners in the various sections in Paris. An experienced officer appointed by government presided over each of these committees, and their deliberations were kept secret from each other. The several reports were then handed into a central committee, who unanimously agreed to publish the following report:

"We have given it our most deliberate attention, and urge that the sulphur fumigating baths should be used in hospitals and great establishments. "The committee think it their duty not to dissimulate on the advantages of this method, which cannot but be applicable also to the service of the camp and the army.

"Done at a meeting held the 22d August, 1815. Signed-Leroux, Dubois, Dupuytren, Richerand, Halle, Pinel, Percy, Barons and Professors of the Faculty of Physic, Paris."

The consequence of this high testimonial has been the establishment of the sulphur fumigating baths in every hospital, prison, and workhouse in Paris-I believe I may add throughout France. So generally are they employed, that at one hospital alone, viz. that of St. Louis, the astonishing

1 If the lead ointment is melted, a larger proportion of finely-powdered chalk can be incorporated. It is a very useful application, and for the formula I am indebted to the kindness of Dr. Green.

number of 180,000 baths were administered in the course of the year 1836. In Germany their value is duly appreciated, and the most eminent physician of Vienna, Dr. De Carro, is using his high influence in their recommendation. By comparing things in our own country, your readers will allow that they manage these affairs better in France. From the great success attendant on their application in a large number of well-authenticated cases in London, it might be justly expected that our most eminent practitioners would be convinced of their high utility, and it cannot be denied that such is the fact, for the baths have been erected in two or three of the London hospitals. However, it is much to be regretted that they have not been in a condition to effect one twentieth part of the good that might be expected. For instance, at St. George's, where, by the instrumentality of Dr. Green, a bath had been fixed, it was at one time allowed to get out of repair on account of neglect in the management. Now a little consideration will show that such a powerful agent should be under the immediate direction and control of an experienced medical officer, and not abandoned to the ignorant hands of a servant. Any one who is in the habit of experiencing the powerful effects of the sulphur-bath, must acknowledge that an opportunity of frequent consultation with an intelligent physician on the spot is quite indispensable. So convinced were the eminent physicians Le Roux, Pinel, Dupuytren, and others, of the importance of the baths being duly regulated, that they refused to sanction the chief apothecary of St. Louis to the office of director, alleging that the superintendence of the fumigatory process should only be conducted by a judicious and enlightened physician. So important does Dr. De Carro view this subject, that he remarks, you might as well abandon the patients themselves to the employment of blood-letting, mercury, opium," &c.

It is to Dr. Green that we are indebted, not only for a very comprehensive Treatise on Diseases of the Skin, but for his successful exertions in procuring the establishment of the baths at St. George's and other hospitals; and not only common justice to that gentleman, but a higher principle should actuate the management, in taking especial care that the suggestions and advice of Dr. Green, supported as they are by the united testimony of enlightened foreign practitioners, should be strictly followed out.

In conclusion, I have only to observe, that as facts speak for themselves, I make no apology for troubling you with the above case; and if the extensive circulation of the Medical Gazette should be the means of attracting the attention of the medical officers of hospitals, poor-houses, prisons, and other large establishments, to the rational and simple, though powerful, treatment of cutaneous and other diseases, by means of sulphur fumigation, I need not regret having requested insertion to these remarks. I am, sir, yours very faithfully, HENRY RONALDS, M. D.

Kensington Gore, June 8, 1838.

Boston Medical and Surgical Journal.-In the number of the Boston Medical and Surgical Journal for Aug. 1, the editor remarks,-"It must have been a mistake in the editor of the American Medical Intelligencer-altogether a mistake-not to have given credit to this journal for the excellent article on Laceration of the Iris, by our correspondent Dr. Davenport, who is one of the best writers on diseases of the eye in the northern states. Had we not been at the extra trouble of procuring a coloured plate to illustrate the case alluded to, perhaps there would have been less necessity for reminding our cotemporary of its remissness in this instance."

Although, however, we accidentally omitted the reference in the place to which the editor of the Boston Medical and Surgical Journal refers, he will find, amongst the "Books Received," in the "Intelligencer," for June 15 (p. 100), the following adequate recognition :

"From the Author.-Boston Medical and Surgical Journal, for May 30th, 1838; containing cases of Laceration of the Iris (with a coloured plate), by Edward J. Davenport, M. D. Boston."-Ed.