BOOKS RECEIVED.

From Jacob Snider, Jr., Esq.-Fifth Annual Report of the Managers of the Pennsylvania Institution for the Instruction of the Blind, located in Philadelphia, &c. 8vo, pp. 36. Philadelphia, 1838.

From the Hon. J. Jackson, of Georgia.-Report of the Committee on Agriculture, to which was referred the memorial of Dr. H. Perrine, late consul at Campeachy, asking a grant of land in the southern extremity of East Florida, for the encouragement of the growth of new and important agricultural products, exotic vegetables and tropical plants, &c. 8vo. pp. 99. Physiologie des Menschen von Friedrich Tiedemann, Lehrer der Anatomie und Physiologie an der Universität zu Heidelberg. Dritter Band. Nahrungs-Bedürfniss, Nahrungs-Trieb und Nahrungs-Mittel des Menschen. Mit Königlich Würtembergischem Privilegium. 8vo, pp. 403. Darmstadt, 1836.

From the Publishers, Messrs. Carey, Lea, & Blanchard.-Popular Medicine, or Family Adviser; consisting of Outlines of Anatomy, Physiology, and Hygiene, with such hints on the practice of physic, surgery, and the diseases of women and children, as may prove useful in families when regular physicians cannot be procured; being a companion and guide for intelligent principals of manufactories, plantations, and boarding-schools, heads of families, masters of vessels, missionaries or travellers; and a useful sketch for young men about commencing the study of medicine. By Reynell Coates, M. D., Fellow of the College of Physicians of Philadelphia, Honorary Member of the Philadelphia Medical Society, Correspondent of the Lyceum of Natural History of New York, &c. &c., assisted by several medical friends. 8vo, pp. 614. Philadelphia, 1838.

The

From the same.-The Medical Formulary; being a collection of prescriptions derived from the writings and practice of many of the most eminent physicians in America and Europe. To which is added an appendix containing the usual dietetic preparations and antidotes for poisons. whole accompanied with a few brief pharmaceutic and medical observations. By Benjamin Ellis, M. D., Professor of Materia Medica and Pharmacy. 5th edit. with additions. 8vo, pp. 231. Philadelphia, 1838.

From Dr. Warrington-Twenty-first Annual Report on the State of the Asylum for the Pelief of Persons deprived of the Use of their Reason: published by the direction of the Contributors, Third month, 1838. 8vo, pp. 21. Philadelphia, 1838.

Formulaire Général ou Recueil de Formules Pharmaceutiqes, adoptées par les differentes Facultées de Médecine, et puissés dans les recueils particuliers de MM. Alibert, Magendie, Henry, Guibour, Chevallier, Milne Edwards, Vavasseur, Cadet de Cassicourt, Foy, &c. Publié par ordre alphabétique. 18mo, pp. 469. Bruxelles, 1837.

Traité de Pathologie Générale, par E. Frédéric Dubois, d'Amiens, Professeur Agrégé à la Faculté de Médecine de Paris, President de la Société Médicale d'Emulation de la même ville, &c. &c. 2eme édition. 8vo, pp. 433. Bruxelles, 1835.

Nouveaux Elémens de Physiologie par M. le Baron Richerand, Professeur à la Faculté de Médecine de Paris &c. &c. 13eme édit. revue et corrigée par l'Auteur et par M. Bérard ainé, Professeur de Physiologie à la Faculté de Médecine de Paris, &c. Edition Belge, augmenté du Traité de Physiologie comparée par F. Tiedemann. 8vo, pp. 535. Bruxelles, 1837.

THE

AMERICAN MEDICAL INTELLIGENCER.

Vol. II.

May 1, 1838.

No. 3.

ART. I.-CASE OF BONY FORMATION IN THE LARYNX.

BY M. M. WHITE, M. D., OF SYRACUSE, N. Y.

To the Editor of the "American Medical Library and Intelligencer." Dear Sir, I give you below the history of a curious and highly interesting case of an extra bone formed in the larynx.

The subject of the case was a man of about fifty-eight years of age,-one of our most valuable, intelligent, and useful citizens,-of robust constitution and sanguineous temperament.

With few exceptions he had enjoyed perfect health up to the commencement of his last illness-in August, 1837. Since that time various anomalous symptoms have existed.

The patient complained at first of only slight indisposition, such as languor, lassitude, and weakness; which finally increased to such an extent that he found it difficult to place himself in any situation which would afford him the rest and repose he so much desired. At this time there were no other symptoms indicating disease.

His appetite and digestive powers were good; his bowels were healthy, and their action natural and regular.

With the exception of a severe headache, which continued for three or four days, but disappeared upon a simple course of treatment, no material change occurred in these symptoms until some time in November following, when he began to complain of rheumatic pains in his ankle joint, extending up to the knee.

In a few days the pain had subsided in the ankle; but with its disappearance there, the elbow and shoulder became similarly affected-were much inflamed, very painful, and continued so for several days,

His appetite diminished, and all relish for food was soon gone. He complained, also, of hoarseness, but so slight was it, that it was only considered as the effect of a little increase of the natural secretions of the larynx. This hoarseness continued to increase with the diminution of the rheumatic inflammation from the elbow and shoulder, until total loss of voice ensued in the latter part of January.

In the early stages of this hoarseness there was no soreness of throat, and no pain was felt either in deglutition, respiration, or upon external pressure; nor did there seem to be any obstruction to a free passage of air into the lungs. In fact, the hoarseness seemed to be the effect of inflammation of an exceedingly chronic character.

During the progress of the disease-which was slow and lingering-his general health materially improved. His appetite returned, and he frequently said to me that he felt better than he had at any time for the last two years, with the exception of this local disease of the throat, which continued to increase.

Deglutition and external pressure upon the throat caused him pain, and at night he had occasional paroxysms of difficult and laborious breathing, which would subside in the morning upon more or less free expectoration.

VOL. II.-3

I should say, also, that throughout the whole of his illness there was a constant feverish dryness of the skin, and a full, quick, and hard pulse.

As it passed on, the disease assumed a more formidable character. Breathing became more laborious and difficult, and a constant sensation of dryness was felt in the throat. Expectoration, which heretofore had been free, with only occasional exceptions, was now almost wholly suspended, and the exacerbations at night greatly increased, and did not subside in the morning as they had done before.

For four or five days previous to the fatal termination of this case, the disease put on all the characteristics of a bad case of croup. The cough which now began to trouble him was in every respect like that of croup, and the paroxysms of difficult breathing were so violent that every attack seemed to threaten him with instant suffocation.

These violent symptoms continued, and the paroxysms of difficult breathing recurred more frequently, until he fell into a comatose state in which he remained for twenty-four hours, when he expired, on the 30th of March last.

On examination after death the pharynx was found in a normal state. The epiglottis was also in a perfectly healthy condition, but the two arytenoid cartilages were greatly thickened and enlarged. On laying open the posterior part of the larynx and pressing it slightly apart, a bony formation was exposed to view, situated at the superior and anterior part of the two arytenoid cartilages, and completely embedded in the muscles and cellular substance within the cavity of the thyroid cartilage.

This bone is about one eighth of an inch in thickness, and is formed of two hardened laminated plates, with a reticular or spongy tissue between them.

The edge of the bone describes an irregular oval line measuring about an inch and one eighth, as situated transversely across the larynx, and seven eighths of an inch in the opposite direction.

This bony plate was slightly curved, to accommodate itself to the inner surface of the thyroid cartilage.

The soft parts which surrounded the bone were in an ulcerated state, and the bone itself was rapidly decaying. A thick, dark-coloured, and very fetid matter surrounded the bone, and communicated with the inner surface of the larynx by means of a small sinus, which opened into it. A part of the cricoid cartilage was also perfectly ossified.

Syracuse, Onondago county, N. Y., April 9, 1838.

M. M. WHITE, M. D.

The foregoing case is one of pathological interest, and in its extent uncommon. Ossification of the cartilages of the larynx, in advanced life, can scarcely be esteemed a pathological condition. It is only when the cartilages become enlarged, the soft parts ulcerated, and the bone carious, that serious inconvenience is usually experienced. The deposition in Dr. White's case was extensive, and was probably the result of some vice, which gave occasion to the bony transformation. That this deposition must have been the work of considerable time is shown by the short period during which the symptoms were urgent. The presence of a bone in this unusual situation probably acted as an irritant; the irritation was communicated to the mucous membrane; ulceration of which supervened, with exposure and consequent caries of the bone, and all the unpleasant consequences.-Ed.

ART. II.-COMPLETE UNION OF THE VAGINA-SUCCESSFULLY TREATED.

BY B. I. HICKS, M. D., VICKSBURG, MISS.

During the month of December last I was requested to examine a servant girl, aged twenty-three years, who had about three years previously a laborious and difficult parturition, when the perineum and vagina were much lacerated; and being entrusted to the care of an ignorant midwife she was not properly attended to-violent inflammation ensued, and union of the walls of the vagina consequently took place. Upon examination I found that there was not the smallest opening for the escape of the uterine secretions. The labia were partially separated, but barely sufficient for the discharge of urine. She had not menstruated since her accouchement. I determined at once to operate, and accordingly prepared my patient by bleeding, purging, and low diet for several days; at the expiration of which time, assisted by my friend, Dr. D. McGill, I proceeded to perform the operation. The patient was placed upon a common table, in the manner directed for the operation of lithotomy. I took a common scalpel, and with the first stroke separated the labia. I then proceeded cautiously and slowly to finish the operation by repeated strokes, using my finger as a guide for the instrument, until I came in contact with the os uteri. I then enlarged the vagina to the natural size. After thus finishing the operation, a quantity of lint was introduced, the patient put to bed, and confined strictly to the antiphlogistic regimen. She had considerable fever for several days after the operation, and complained of considerable soreness; but by being confined to arrow-root and mucilaginous drinks, these symptoms soon subsided.

I found great difficulty in preventing the vagina from contracting and reuniting while using the lint, and was compelled to resort to the use of a bougie, made in the form of the common rectum bougie, coated with gumelastic, which my patient wore for several months. The mucous membrane has completely formed over the internal surface of the vagina. The patient is now entirely well, and has menstruated healthily four times since the operation. B. I. HICKS, M. D.

March 17th, 1838.

ART. III.-COMPRESSION OF THE CAROTID ARTERY IN THE TREATMENT OF CONVULSIONS.

BY M. TROUSSEAU.

In one of the late French journals' a case of convulsions, cured by the above means, is published by M. A. Trousseau, of Paris. He was called on Monday, 11th of September, 1837, in consultation with Dr. Cerise, conjointly with Professor Chomel and Dr. Toirac. The case in question was a child, whose histoty is as follows:

Our young patient is eight years old, and has been troubled for several months with a second dentition. At the end of August of this year he became affected with very slight scarlatina, which required nothing more than the simplest hygienic treatment.

"Eight days after the appearance of the eruption, the child, which was perfectly well, requested of its mother to be carried to the Tuilleries. It was a warm day and she consented. No injury resulted from it; but the third day after going out, the temperature suddenly lowered, and the parents thought that slightly warmer clothing would protect it effectually against the premature coldness of the season. The child, notwithstanding, took cold, and the face next day was swollen, especially in the parotidean region. Edema quickly covered the whole body; but it was not considerable. At the same time he had suppression of urine which lasted seventy-two hours; afterwards flowed in small quantity, and was of a rather deep brown colour.

1 Journal des Connaissances Médico-Chirurgicales, Octobre, 1837.

"The oedema had decreased a little on the 10th of September, and in the evening the child complained of slight headache. He passed a disturbed night, and in the morning had violent cephalalgia, with unusual loquacity. He vomited, although he had only taken very light food.

"At three o'clock in the afternoon, M. Cerise saw him, and as he presented so extraordinary an appearance, and with a pulse so irregular, he remained three quarters of an hour with him, anxious and endeavouring to account for what was going on. When suddenly the child was seized with very acute pain in the head, to which he carried his hand, uttering a cry of great distress, and had a violent convulsion of the epileptic form, which only continued a few moments, and was followed at first by stupor, then by a perfect delirium; it was then a quarter to four o'clock.

"M. Cerise ordered ten leeches to be immediately applied behind the mastoid processes, and had the arms, legs, and all the abdomen covered with large sinapisms. At half past four he was again attacked more violently and of longer duration than at first. At a quarter past five a third occurred. At a quarter to six there was a fourth convulsion, which continued till the accession of another."

At M. Trousseau's arrival, at a quarter past seven, he was stretched upon his bed, his head powerfully turned behind and to the right, the jaws, eyelids, globe of the eye, muscles of the neck, the arms, and the right leg, were agitated with frightful jerking convulsive motions. The muscles of the left side were in a state of complete relaxation.

The head had been covered with ice, yet the convulsions continued; cold water had been dashed on the face, the cheeks had been struck with a handkerchief dipped in iced water; nothing moderated the symptoms.

The pulse acquired an extreme frequency, it was tumultuous, and beat a hundred and sixty times in the minute. The respiration was embarrassed, and became rattling; it was evident that the lung was congested and the bronchial tubes were beginning to be filled with mucus. The pupils were very much dilated.

In this juncture M. Trousseau proposed a cold affusion, of not more than half a minute's duration; for he was aware that the nervous system could only react feebly. Messrs. Cerise and Toirac adopted this medication, and the child, placed naked in the bath-tub, received a shower-bath, with the water at 54° Fahr.

No kind of change resulted from it: and the child had been given up when the idea suddenly struck M. Trousseau of mechanically preventing the progress of the blood to the brain. There was but one mode, and that was to compress the primary carotids against the sides of the trachea; before fifteen seconds had elapsed the convulsions rapidly ceased, and the child fell into an apoplectic stupor.

The compression was continued without interruption for an hour, and not the slightest convulsive jerk was manifested. From this time convalescence made rapid progress.

M. Trousseau thinks the above mode would be useful in congestive convulsions; for the compression of the carotid artery throws the whole of one hemisphere of the brain into a state of anemia much quicker and more certainly than bleeding or the application of leeches.

The immediate effect of this pressure on a person in good health is very remarkable. The face becomes pale, a feeling of cold is experienced, of dimness, and sometimes a confusion of ideas; all these cease the instant the blood is allowed to reach the brain.

If both sides of the body were equally convulsed, synchronously or alternately, would there be any inconvenience in compressing both the carotids? he asks. It is easy to be convinced, in performing the experiment upon oneself, that the simultaneous compression of both carotids does not present the same inconvenience which might be feared at first sight. This experiment should be made when in bed. The sight becomes obscured, the ideas are slightly confused, an indefinable state of annihilation (anéantissement)