Infirmary for Hernia.-A prospectus has been issued for an Infirmary for the relief of poor persons labouring under Hernia; to be opened in this city on Monday, the 3d day of December, 1838, and to be under the competent care of Dr. Heber Chase-so well known for his success in the management of hernia, and of Dr. Reynell Coates, one of our best informed surgeons; the former being the attending, and the latter the consulting, surgeon.

A Successful Plan of Arresting the Destruction of the Transparent Cornea from Acute Purulent Inflammation of the Conjunctiva. By FREDERICK TYRRELL, Surgeon to St. Thomas's Hospital, and to the Royal Ophthalmic London Hospital. Read before the Royal Medical and Chirurgical Society, May 22, 1838.-The author having often had occasion to witness the insufficiency of the means commonly resorted to in the treatment of acute purulent inflammation of the conjunctiva, to arrest the sloughing process in the transparent cornea, was induced to study the disease most attentively, in the hope that a knowledge of the mode in which the morbid change takes place, might suggest some adequate means of controlling it. In this hope he was not disappointed, having devised a remedy, the success of which has been sufficient, in his opinion, to warrant him in offering it to the profession. The cornea being, in the author's opinion, almost altogether dependent for its supply of blood upon the conjunctival membrane extended over it, he conceives it to be demonstrated that, in the high degree of chemosis attending upon acute purulent inflammation of the conjunctiva, its supply of blood must be cut off by the mechanical strangulation of its vessels, from which condition sloughing of the whole or a part of the cornea (according to the degree of strangulation) must necessarily result. The plan of treatment, therefore, recommended by the author, consists in dividing the fold of conjunctival membrane, which, by its reflection, constitutes the chemosis, in order, by relieving the distension of its vessels, to diminish the degree of chemosis. The novelty of the plan consists, not merely in the division of the conjunctiva, which has been long practised by many others without the least benefit, but in dividing it in a radiated manner, from the centre of the cornea towards the sclerotic margin, in the intervals between the insertions of the recti muscles, whereby the large trunk of the vessels supplying the conjunctiva are avoided. The method, hitherto pursued by many surgeons, of dividing in a circular direction parallel to the margin of the cornea, not only produced no advantage, but was even prejudicial, by cutting off, more perfectly than before, the vascular supply from the cornea. Several cases are related, in which this practice was adopted in persons presented to the author, some in a very advanced stage of inflammation, and after sloughing of the cornea had actually commenced, in which the morbid processes were immediately arrested by its adoption, and the paper concludes by claiming for it the attention of the profession on the following grounds:-That it is safe and easy of performance; that it is more efficacious than any plan hitherto proposed; that it prevents the necessity of active depletion, or the adoption of any more general or local measures, likely to injure the general health or to produce severe suffering.

Mr. Davis was two years in Egypt with the British army, and saw many cases of chemosis. The means resorted to at that period consisted of general bleeding, opening the femoral artery, and dividing the conjunctiva. Army surgeons were not at that time provided with leeches or cupping instruments. He had divided the conjunctiva in hundreds of cases, and so far as that experience went, the proceeding was a most unsatisfactory one;

Lancet, June 2, 1838, p. 342.

the reason why it was so had now been explained by Mr. Tyrrell. General bleeding, as a means of treatment, he had also found most unsuccessful, the disease spreading with a frightful rapidity; he had seen cases in which the cornea had been destroyed in two hours after the first application of the patient to the surgeon. Directions were given that any man who had a sensation of something gritty in his eye should at once apply to the hospital, when an application of tincture of opium was made (the vinum opii not being then in use), and hundreds who thus early applied, and were subjected to this treatment, experienced no further inconvenience, a profuse flow of tears being produced, and the symptoms subsiding. He had himself experienced thirteen attacks of the disease, eight of which had occurred to him in this country. It might not now be of much practical importance to mention, but it was a curious fact, that scarcely a person died of dysentery in whom, during the last moments, ulceration of the cornea did not come on.

Reporting Progress!-The following anecdote is given by Dr. Hosack, in his Lectures, to which we attracted the attention of our readers in the last number:

"On this subject let me tell you a little anecdote, which I had from Dr. Rush. The doctor had a patient extremely ill, in the Pennsylvania Hospital, for whose recovery he experienced great anxiety. He left him very low, not expecting his recovery. The old nurse of the house was no less attentive to his situation; her anxiety kept pace with the doctor's. She watched the patient very narrowly; nothing escaped that she did not know. In a short time a change was effected. In a little time down came old Molly, the nurse, who felt as much anxiety on these occasions as the doctor himself. The old lady impatiently asked for the doctor, 'Well, doctor, our patient is out of danger!' Ah, indeed!. how do you know, Molly ?? Ah!' says she, 'I have one sign, doctor, that never, never deceives me.' 'Well tell me, nurse, what is that?' 'Oh, you must excuse me, doctor, but I know he is a great deal better.','I must know that secret, nurse.' The doctor was determined to sift Molly to the bottom. 'Well, saving your presence, sir, if I must tell you, he just this moment let go a most terrible When you get this signal, this 'signum salutis,' you will remember that your patient is in a good way."

6

Umbilical Abscess, containing several Ascarides Lumbricoides.'A young man, aged fifteen, of a leucophlegmatic temperament, has been affected with tabes mesenterica for some time; emaciated; languid; confined to bed with swollen abdomen; digestion deranged; constant fever. He had been in this condition for a year, when he felt a painful pricking sensation in the left region of the transverse colon, about four fingers breadth from the umbilicus; the urine was turbid; fæces yellow, nearly liquid, mixed with a whitish fluid; pupils slightly dilated. After continuing for fifteen days, the pains about the umbilicus became most violent; the part presented a red appearance, and was accompanied with fever; an abscess showed itself, which burst spontaneously, and discharged healthy pus. On the fifth day of the opening, along with the pus, which flowed copiously, a worm, of the class ascarides lumbricoides, was discharged; it was from five to six inches in length, and about the size of a goose's quill. A few days after a second was discharged, similar to the first; afterwards a third, and on the ninth day a fourth. Some days subsequently another worm escaped, which was alive, and larger than those which had preceded; at the same time matter of a fœcal odour was discharged. Shortly the tumour became dissipated, the opening closed, the discharge decreased, digestive functions improved, strength and health re-appeared, and the young man acquired embonpoint.

1 II Filiatre Sebizio.

Obstinate Constipation at length cured by Air Injections. By DR. GERLACK, of Czarnicow.'-A feeble scrivener, 18 years of age, bearing the marks of confirmed scrofula, experienced on the 31st of August (1837) loss of appetite and nausea; the tongue was coated, and some pain present in the abdomen. He took an emetic, principally of ipecacuanha, with some admixture of antimony, and vomited mucus and then bile. As the bowels were not moved, he was ordered the next day a solution of epsom salts, and warm aromatic herbs were applied to the abdomen. Dr. G. then left him for several days, during which the patient took, of his own accord, glauber salts and infusion of senna, without producing an operation. On the 7th of September, when visited again, he was found throwing himself about in agony, his countenance expressing great anxiety; the tongue was covered with a mucous coat at the edges, dry and red in the centre; the breath was fetid; the pulse rapid, small, irregular; offensive eructation; retching and vomiting of mucus and of the liquids swallowed to alleviate the thirst; the abdomen spasmodically contracted; the mesenteric glands hardened; pain over the whole abdominal surface, especially on the left side of the navel, where, however, no swelling could be detected; the urine sparing and deep red; the patient exhausted by pain and loss of sleep. Dr. G. learned that the patient, previous to the invasion of the disease, had eaten freely of fruit, and especially a large quantity of unripe pears, with the skins and seeds; and as the most careful examination furnished no evidence of rupture, was disposed to consider the case as obstruction of the canal by undigested food, which had by its continuance produced inflammation of the intestine. In this view we directed twenty leeches to be placed on the most painful part of the abdomen, a powder to be taken of six grains of calomel with one grain of hyosciamus, and an evacuant injection containing vinegar and salt. These remedies proving insufficient the calomel was given in a ten-grain dose, to be repeated in two hours, and air injections prescribed. The latter proved very painful to the patient, but after being frequently repeated, so as obviously to distend the abdomen, at length brought away a large quantity of hardened fæces, including several cherry stones, and numerous undigested portions of pears with the seeds. Voluminous stools followed this evacuation, the disease assumed a favourable aspect, and perfect cure followed in a few days on this simple treatment.

Case of Lead Colic, followed by Intermittent Diarrhea. By DR. CLESS, of St. Catharine's Hospital, at Stuttgard.2-A man, 32 years of age, came into the hospital, affected with lead colic and paralysis, for the fifth time within six years. After the colic had been relieved, and the palsy considerably benefited by the employment of strychnine externally, combined with aromatic baths, there occurred on the 23d of August (1836) diarrhoea, with paralysis of the sphincter ani. On the 8th of September, the evacuations suddenly ceased, and gave place to a state of mind bordering on fatuity, which continued till the 15th. On this day the loose evacuations recurred, but the intellect of the patient was restored, and as suddenly as it had previously been impaired. The extremities, however, soon became cold, and the patient sunk. From one to two ounces of clear serum was found in the lateral ventricles of the brain.

Fatal Nephritis occasioned by a common Fly Blister. By DR. NIEMANN, of Magdeburg.3-Charles B., ætat. 5, was ill with catarrhal fever and hoarse cough. During the night exacerbation of the symptoms took place, and the parents called in a country surgeon, who ordered a large blister. One of

Med. Zeit. v. Vereine f. Heilk, in Pr. 1838, Nr. 3. Med. Corres. bl. d. Würt. ärztl. Vereins. Bd. vii. Nr. 119. 3 Leipsig Summarium der ges. Med. Feb. 1838.

the size of two hands was laid over the whole chest. Called to him the next day at noon. Dr. B. found vesication extended over the whole epigastrium, and portions of the ointment still adhering. The child had high fever, pain in the course of the ureters, and stoppage of water. Dr. B. directed the remainder of the ointment to be washed off with warm water, warm fomentations, leeches to the region of the kidneys, and an emulsion of poppies with camphor. The pain however increased, priapism took place, the prepuce became cedematous, and the trunk, feet, hands, and face swelled. The pulse was now small and thready, and the skin cold, with clammy sweats. The child passed the night without sleep, notwithstanding an opiate. The pain in the left nephritic region became insupportable. The urine was passed by drops and bloody. The case terminated fatally the fourth day. Dissection disclosed inflammation of the peritoneum and left kidney, the substance of which was deep red; no urine in bladder; no trace of gangrene in the cavity of the abdomen. The case was obviously one of nephritis, induced by absorption of cantharides, and suspending the urinary secretion, whence general anasarca. This is one of many warnings on the application of blisters to children.

Extra-Uterine Fætation. Gastrotomy. Cure.'-On the 15th of September, 1837, Dr. Zwanck, of Hamburgh, was called on to attend a female, who had experienced labour pains for the last three days; on examination he discovered an extra-uterine pregnancy. Gastrotomy was performed on the following day; an incision, five inches in length, was made along the linea alba, and the chorion exposed, which presented a tendinous appearance; the membranes were now divided, and the foetus brought into view, but the incision was found to be too small to admit of its extraction; the opening of the abdominal parietes was, therefore, enlarged by half an inch, when the fœtus was removed without difficulty; in a few moments more the placenta presented between the edges of the wound, and was also extracted. The wound was united by five sutures, and after a lapse of three weeks the woman was perfectly well. The child also survived, and at the time of the publication of this case was a strong healthy boy..

History of the Controversy in the University of the City of New York; with original documents and an appendix. By the Professors of the Faculty of Science and Letters. 8vo, pp. 78. New York, 1838.

From Dr. Oppenheim, in Hamburg.-Zur Jubel-feier des Professor Emeritus Dr. Johann Busch in St. Petersburg, am 26sten Mai, 1838. Mit dem Bildneisse des Jubilars. 4to, st. 32.

Zustand oder Richtung und Leistung der deutschen Medicin im Jahre, 1837, mit besonderer Beziehung auf Journalistic. Ein literär-historischer Versuch von Dr. E. Nathan, practischem Arzte in Hamburg. (Aus Fricke's und Oppenheim's Zeitschrift f. d. gesammte Medicin, Band 8, Heft 3.) Svo, s. 71. Hamburg, 1838.

Ueber den Zustand der Heilkuude und über die Volkskrankheiten in der europaischen und asiatischen Türkei. Ein Beitrag zur Kultur-und Sittengeschichte von Friedr. Wilhelm Oppenheim, Doctor der Medicin und Chirurgie, u. s. w. 8vo, s. 144. Hamburg, 1833.

1 Casper's Woch., Archives de Méd., June, 1838, and Lancet, Sept. 1, 1838, p. 801.

In the absence of absolute demonstration of the true structure of the iris, we should pursue the method which has been frequently pursued in such cases with the most beneficial results to science, viz., to adopt the theory which will satisfactorily explain most of the phenomena. Let us then examine the principal phenomena observed with regard to the iris. It contracts on the admission of light through the pupil of a healthy eye, and expands when the light is obscured. Its action is involuntary, although a control of it by the will is possessed by some individuals, and some of the inferior animals. The proximate cause of its contraction is the sensation conveyed to it from the retina caused by the direct action of light on this nervous expansion. It is therefore incorrect to argue as some do, that the iris is a muscle, because it contracts on the application of its appropriate stimulus, and that stimulus is light, for the iris is insensible to the direct action of light. In order to ascertain how this contraction is brought about, we must first investigate the nervous connection between the retina and the iris. Does the impression made on the retina travel along the optic nerve to the brain, and through the connection between the third and fifth pairs with the ophthalmic ganglion to the iris? Certainly not; for the brain does not take cognisance of its motions. Brodie has seen the iris contract from the presence of light, and dilate from its absence, although the patient lay in a state of complete insensibility, and did not seem to be at all conscious of the impressions made on the retina.' Hennen has even seen these phenomena reversed, the iris expanding on the admission, and contracting on the exclusion of light. The impression then evidently travels along the optic nerve to the brain, but in its passage affects the ophthalmic ganglion seated upon this nerve, and thence is transmitted along the ciliary nerves to the iris. For this purpose this ganglion has been placed very near the ball of the eye, and is very closely and firmly adherent to the optic nerve, almost surrounding it like a sheath. It is not necessary that the ganglion and nerve should have connecting filaments in order that nervous sensation might be transmitted directly from one to the other; mere apposition is sufficient, as has been proved by dividing nerves and placing their ends in contact. The ciliary nerves belong to the ganglionic system, except those branches which are derived from the first branch of the fifth pair. The connection of the third and fifth pairs of nerves with the ophthalmic ganglion should be considered merely as secondary, and by no means to possess the influence ascribed by some,-for instance, Walker, of Manchester, attributes the power of contracting to the fifth pair, and of dilating to the third pair. As well might all the phenomena of the great sympathetic be attributed to its connection with the enternal motor and vidian nerves. This idea has arisen from the erroneous supposition that the union of these

1 Cooper's Surg. Dict.

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VOL. II.

2 Ibid.

3 Dunglison's Human Physiology.