of this imperfection. Although Amussat has operated frequently, and presented this subject at some length before the Académie, as also exhibited several cases, said to have been entirely cured by the section of the genio-glossi, still there is a doubt as to the correctness of his reports, and he has been accused by some very respectable surgeons of charlatanism, even publicly through the medium of the medical journals. I have been present during several of his operations, and must confess to have never been entirely satisfied of the much boasted improvement in the speech of his patients, immediately after the division of the muscles, and I have never, but in one or two cases, been fortunate enough to meet with those operated upon, after the lapse of a short time, and in these two, the operation did not appear so flattering as I had at first supposed. But little has yet been published on the matter except a few straggling accounts met with occasionally in the Medical Gazettes.

A new idea is now gaining ground in reference to the cause and surgical treatment of myopia as it is presented to the Académie by Guérin. He supposes that there are two kinds of this affection, namely, myopie mécanique or musculaire, and myopie optique or oculaire, the former resulting as strabismus in the primitive, shortening or active retraction of the muscles of the eye. The diagnosis of these two forms, requires some nicety of examination to prevent the injurious application of the surgical means proposed.

The characters of myopie mecanique, are somewhat similar to those furnished by strabism mécanique, besides a slight deviation of the eye from its natural axis, the form of the globe oculaire is a little changed, and the movements of the organ restricted. The anterior half of the globe of the eye is more conical, the cornea representing a segment of a sphere, with a greater convexity than natural; the sides of the globe are depressed and stretched in the direction of the muscles that are retracted. The movements as before stated are affected, being more or less circumscribed either upwards or downwards, internally or externally, according to the contraction of the different muscles affected. The active treatment of myopie mécanique, you will have already anticipated, consists in the division of the muscles concerned in producing this unnatural state of the eye. Guérin states that he has operated with marked success in several cases, and of course his statements are worthy of all credit.

At the Hospital de la Pitie, the service of Piorry, a professor in the medical school, I have seen the sulphate of quinia used in a wholesale manner, for the treatment of intermittent fevers, which this gentleman considers to be caused by and dependent upon enlargement of the spleen, which hyperthophy may be produced by some external or internal agent. But he asserts, that the fever cannot exist without the enlargement and derangement of this viscus, although the spleen may be hypertrophied and engorged for a time without producing the fever. This theory of course has many disciples, and many enemies. He makes use of this medicine in the enormous doses of fifty and one hundred grains; I have often very satisfactorily percussed the spleen, and marked its limits most accurately before the administration of this medicine in the above doses, and in the short space of twenty minutes after its exhibition, I have seen this organ very perceptibly diminished in its whole circumference, and the paroxysms of the fever arrested or palliated in an incredibly short time. Paris, March 29th, 1841.

62. Medical Schools of Berlin and Vienna.-[Extract of a letter from Dr. T. H. WATTS, of England, to Dr. PLINY EARLE.]-The schools of Berlin and Vienna are the best in Germany, and the superior characteristic of their style of teaching is, much specialty of study. They have courses of lectures and clinics on the diseases of the eye, the maladies of children, the disorders of women, midwifery, clinics, and polyclinics. I have derived immense advantage from my tour through their numerous schools. I was about five months in Berlin, attending the great Jungken on the eye, and Rust and Dieffenbach on surgery; but at Vienna alone I remained nearly ten months, and left it with deep regret, for it has the first practical school in the world-not for the young student No. III.-JULY, 1841.

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or mere tyro in the profession, but for him whose mind is already well prepared. It is immeasurably superior to all others for morbid anatomy, eye diseases, and midwifery. The Civil Hospital alone counts about forty thousand admissions yearly; there are upwards of three thousand choice autopsies every twelve months, and these are open to the public. The professor of morbid anatomy and his assistant are always in the dead house at fixed hours, at morning and noon; and have the exclusive right, for themselves and their class, to open the bodies, and nowhere have I seen this part of medical inquiry made with equal care and exactness. There is still more liberality in the medical department in Vienna, than even in Paris, and foreigners are admitted scot free. Besides the general medical and surgical clinics, there are two excellent clinical courses on diseases of the eye. The one is given in German by the immortal Jaeger, in the Military Hospital, and the other in the Latin tongue, by Rosas, in the great Civil Sick-house. By a happy method of centralization the asylums for disease in Vienna are all accumulated in the same quarter of the suburbs.

The other universities I visited in Germany were in smaller cities, and as I travelled for bare practical information, I never prolonged my stay in one of them above a week or twelve days, for I studied to keep mostly to the grand metropolitan sites. I have always found the large metropolis superior for medical inquiry, except in Italy, where Rome stands certainly the lowest as a school of medicine. It is even excelled by miserable Parma."

Paris, December 13, 1840.

MISCELLANEOUS.

Necrology.-The foreign Journals for the past three months, announce the deaths of several very distinguished ornaments of the profession. Among these we may notice, Dr. Hope, author of a valuable work on the diseases of the Heart, and assistant physician to St. George's Hospital; Dr. Ryan, the author of several works on Midwifery, &c., and formerly editor of the London Medical and Surgical Journal; Esquirol, chief physician to the Hôspice de Charenton, and author of a most valuable Treatise on Insanity, and other works; Landré Beauvais, former Dean of the Faculty of Medicine; and Mad. Boivin, well known, both as a successful writer and practitioner of midwifery. She was a Doctor in medicine, for many years Superintendent of the Maternité at Paris, and a member of most of the learned societies of Europe.

Biography of Dupuytren.-A highly interesting biography of Dupuytren, by Professor Cruveilhier, has recently been published in Paris.

Hôpital de Charenton.-M. Foville has been appointed physician in chief to this hospital, in the place of Esquirol, recently deceased.

AMERICAN INTELLIGENCE.

Dysphagia from Scrofulous degeneration of the Esophagus of five years standing, cured. By EZRA P. BENNETT, M. D., Danbury, Ct.-The subject of this case was a young lady by the name of Mary Edwards, from the town of Sherman, in the north part of this county. She first consulted me in November, 1840. She is 19 years of age, of delicate slender form, with sallow countenance, black eyes and hair. Her general health was bad; the menses were irregular, and she complained of lassitude and debility. She said that about five years since she began to experience a little difficulty in swallowing, which had gradually but steadily increased until the present time. She could not swallow any substance as large as a common pill, without dividing it into two or three pieces, and she then swallowed it with difficulty. The pharynx was dilated upon each side into pouches of considerable size, so that when she swallows fluids, they at first appear to pass into a cavity, and then with a gurgling noise pass down the esophagus. She complained of no pain in the throat, except after exposure to cold. After eating there was a smarting sensation, which, however, soon subsided. I attempted to pass a bougie into the throat, but was wholly unable to do so, although I made the attempt at different times. Although the instrument was of small size (not being larger than a medium sized catheter,) I could by no possible means make it pass the stricture; it would pass down about five inches from the incisor teeth and stop abruptly. If it was pressed upon, or rotated, it passed immediately into the glottis, and had to be immediately withdrawn to prevent suffocation. To satisfy myself that it really entered the rima glottidis I substituted a catheter for a bougie, which, when introduced in the same manner, permitted her to respire through it, which removed all doubt upon this point, and proved most conclusively that the instrument was in the trachea. From her general appearance, and from the history of her case, I came to the conclusion that the disease was of a scrofulous character, and that the difficulty of deglutition depended upon a scrofulous degeneration of the coats of the esophagus. Having come to this conclusion, I commenced a course of medication in accordance with these views. I gave her a pill of conium, ipecac. and blue mass, three times a day before eating, also 20 drops of the iodide of iron three times a day half an hour after eating, directing at the same time the neck to be rubbed with iodine ointment morning and evening. Having continued this course of treatment for a few weeks I again attempted to pass a bougie into the throat, but was as before unsuccessful. Foiled in my repeated attempts to introduce a bougie, I began almost to despair of doing her any good; but I resolved to make one more trial, and that with a different instrument. I procured a flexible piece of whalebone, to the end of which I attached, by means of a screw, a small but perfectly smooth ball of ivory; the size of the ball was about that of an ordinary sized pea. Armed with my instrument, I again

returned to my task, and soon had the satisfaction of passing it through the stricture, though not without using considerable force. The passage appeared to be hard, indurated, and quite rough and knotty. After the instrument was withdrawn, she spit up some blood and complained much of pain in the stomach, which lasted for two days, and was so severe as to require full and repeated doses of morphine to subdue it. As soon as the soreness of the throat had subsided, I again introduced the instrument. By pursuing this course for four or five weeks, I found that the instrument passed with ease, and I therefore substituted a larger one, which I gradually increased in size as the passage dilated, by dipping it in melted wax. In this way the dilatation was very gradual and almost without pain, and in four months from the commencement of the treatment my patient left town in good health and fine spirits. The induration and raggedness of the œsophagus has entirely disappeared, the pharynx has regained its usual size, and she swallows with the utmost ease and facility. The blue mass and ipecac. was continued only for a few weeks; but the conium and iodine were continued through the whole course of treatment, with an occasional intermission of a few days. The instrument used in this case I think better adapted to overcome such difficulties than a bougie, as it has no point, and will not therefore be obstructed by the ragged and uneven surface of the œsophagus. Neither will it so easily pass into the glottis, and being more firm, it can more readily be guided into the tube, and when there can be pressed upon with more force and precision. I do not think that in this case I should have ever succeeded in passing a bougie.

Case of Congenital hypertrophy of the upper eyelids, and mucous membrance of the upper lip, with an inversion of the eyelashes. By H. H. TOLAND, M. D., of Columbia, S. C.-In the spring of 1838, a male slave, ætat. 22, the property of Dr. S., was placed under my care, who had at birth an unusual fulness of the upper eyelids, produced by an unnatural development of the skin and subcutaneous cellular tissue; accompanied by an inversion of the eyelashes, and an almost entire want of control over the motions of the lids. The entropium had produced, from the irritation that had been so long kept up, an entire opacity of the cornea of the right eye, and a partial one of that of the left. If the eyes had been in a healthy condition, he could not have had perfect vision, in consequence of the inability to separate the lids.

The upper lip seemed as if it were partially everted, and the mucous membrane projected an inch below its junction with the skin, and covered or hung over a part of the under lip. Being in constant pain from the inflamed state of the eyes, and without value, we determined to make an effort not only to remove the entropium, but also to improve his appearance.

A portion of the skin of the upper lid of the right eye, was taken up between the fore-finger and the thumb, so as to evert the eyelashes, and removed with a scalpel, from the external to the internal angle of the eye, leaving a wound of a semilunar shape. The portion of integument excised did not exceed an inch in width in the centre, and diminished gradually to the extremities. After the removal of the skin, a large quantity of condensed lamellated cellular substance presented, and was removed. The wound was closed by the interrupted suture, the points being sufficiently numerous to bring the edges in direct contact.

Considerable inflammation followed the operation, but soon yielded to purgatives, with the constant application of warm water to the eye during the day, and a poultice of bread and water at night. It probably depended both on the distension of the remaining integuments of the part, as well as the number of ligatures that were found necessary to bring the edges of the wound in contact.

The ligatures were removed on the fifth day, the wound having almost entirely healed.

In a week the same operation was performed on the left eye, with a similar result. The appendage to the upper lip was also removed at the same time with a scalpel, and found to consist of the mucous membrane very much thickened, but not otherwise altered in structure. The quantity of cellular substance was increased considerably, and the labial glands somewhat enlarged. The wound was close by the interrupted suture, and united readily.

The opacity of the cornea of the eye in which it was partial soon disappeared, and diminished slowly in the other. His sight is now good. The entropium has not returned; and the deformity produced by the unnatural state of the lip is removed.

This case of entropium is the more interesting, as it was congenital, produced by the hypertrophy of the eyelids, accompanied by a similar affection of the upper lip.

He has perfect control over the eyelids, although the margins are almost in contact with the eyebrows. The mother of the boy, the subject of the affection under consideration, was at the time of his birth the property of a physician, who entertains no doubt as to the difficulty being congenital.

A few days ago, now almost two years since the operation was performed, he was perfectly well, and is as valuable as any negro on the plantation to which he belongs.

An Essay on the beneficial results of Statistical Inquiries, in their application to Charleston, tracing the increased mortality to Quacks and Quackery. Dr. THOS. M. LOGAN read before the Charleston Apprentices' Society in May, 1841, an Essay, of which the above is the title, and the purport of which is similar to the one by Dr. Samuel Cartwright of Natchez, an extract from which was inserted in the January No., 1841, of the American Journal of the Med. Sciences. In the latter article the result of the empirical was contrasted with that of the regular practice of physic in Natchez; and to this article Dr. Logan acknowledges himself indebted both for the argument and plan, as well as idea of his own investigation as to Charleston. It seems that it was the fortune of Dr. L. to publish in the July No. for 1836, of the Southern Literary Journal, some remarks" on the climate and health of Charleston," tending to prove the then increasing salubrity of that city, and its advancement, pari passu, with other prosperous cities, in the social ameliorations and blessings of long life, which obtain in other well regulated and enlightened communities. Since that period an opposite state of things has taken place; not only has the population sensibly diminished, and the mortality alarmingly increased; but the laws which encouraged sciences and protected and guarded the citizens have been annulled, and a murderous set of quacks and empirics turned loose upon the credulous public. In such a state of things, Dr. L. felt it to be incumbent on him, inas. much as he was among the first to felicitate the inhabitants concerning their advancement in civilization in 1836, to sound the tocsin of alarm, and to warn them now of the fatal change which has taken place in the medical police of the city, and arouse them from their supposed security and immunity. After a copious disquisition to prove the correctness of the proposition, with which he