in the Materia Medica an agent whose just pretensions are more compromised by a slovenliness and want of care in its exhibition, than mercury. And although, in some cases, the peculiar circumstances under which the medicine is exhibited, prevent the conditions of restricted diet and confinement being complied with; and, therefore, the physician prescribes it under disadvantages, of which, although he is aware, yet he cannot control them; still we believe, from the little importance attached to these conditions when they might be enforced, that most physicians have yet to learn to what extent they modify the action and effects of the medicine. Upon inattention to these circumstances we should charge, in many instances, the complete failure of mercury to affect the system; and in all, that when the system is brought under its influence, so much more of it is required to produce this effect."

Dr. Law is certainly mistaken if he supposes that well-informed physicians and surgeons are ignorant that warmth and low living accelerate and augment the specific action of mercury. There are few amongst us who are not aware of that.

Patients are not usually submitted to this regimen, because as a general plan it would probably rather be injurious than beneficial. Many under such circumstances would become profusely salivated, and we should return to the old regime of spitting-pots and erethismus. The great improvements in the treatment of syphilis have been in discarding confinement and low living, in allowing moderate and judicious exposure to the open air, in enjoining a reasonably good diet, and in combining with the mercury, sarsaparilla or other tonics, which maintain the general health, and certainly do not promote salivation. The benefits of this plan have been displayed on a large scale in the Lock Hospital of London, and we dare say elsewhere, and occasional exceptions do not eat up the rule. That there are such exceptions all men of experience are sensible. Though fully impressed with the value of open air and moderately good living in the treatment of syphilis, yet we now and then meet with instances in which we cannot shut our eyes to the superiority of a contrary mode of proceeding, and in which we enjoin confinement and court salivation.

But Dr. Law proceeds to another inquiry, and has arrived at another result:— the very small quantity of mercury required to affect the system, when exhibited is minute doses at short intervals.

This quantity was much smaller than we could have had any idea of. The first cases in which we made trial of this mode of giving mercury were chronic cases, such as we felt would, without injury or detriment, await the result of our experiment. We made no particular selection of cases, but such as were labour. ing under affections which we ordinarily treated with mercury. We directed one grain of calomel to be mixed up with a sufficient quantity of extract of gentian to make a mass to be divided into twelve pills, one of which was to be taken every hour. We found, in some cases, salivation produced by twenty-four pills, or two grains of calomel; and seldom were forty-eight pills, or four grains, required to produce this effect. We would say, that thirty-six pills, or three grains, was the average quantity required to effect salivation. We exhibited blue pill in the same way, and found the mouth to become sore from six grains." Dr. Law specifies many other cases. We will notice two or three.

Anne Carey, aged 46, affected with periostitis of the femur, had her mouth made sore with two grains and a half of calomel.

John Curran, aged 40, labouring under sub-acute rheumatism, with enlargement of the joints of the wrists, was profusely salivated with three grains and a third of calomel: a decided amendment followed.

John Lynch, aged 36, affected with indolent enlargement of both testicles, particularly the right, was ordered a twelfth of a grain of calomel every hour, and to rub ten grains of mercurial ointment on the right testicle every night. He had only taken two grains and two-thirds of a grain, and rubbed twice, when

he became salivated. The induration and enlargement of the testicles completely disappeared.

Anne Clare, aged 40, affected with periostitis of the clavicle, was salivated with three grains, and ten-twelfths of a grain of calomel. Salivation continued for a month.

It is unnecessary to swell the list. But the following case may be added to it.

"We anxiously looked out for a case of Iritis to test this method of exhibiting mercury, when one presented itself, in John Gleece, labouring under syphilitic rheumatic pains, with Iritis of the right eye. The conjunctiva was moderately injected, the cornea unusually prominent, and the pupil irregular. We ordered him the twelfth of a grain of calomel every hour. When we paid him our second visit, we found the eye quite clear, no unusual vascularity, and the pupil quite regular. He had only taken eighteen pills, or a grain and a half of calomel; but the gums exhibited no marks of being affected. As the rheumatic pains continued, we determined to persevere in the use of the mercury, and in the same fractional doses, till the mouth became affected. We were surprised to find that this effect was not produced until he had taken one hundred and seventy pills, or fourteen grains of calomel. This seemed to be by much the most refractory case we had met with; however we discovered, that, in order, as he thought, to make assurance sure, instead of complying with our directions of only taking one pill every hour, after the second day, and after experiencing the benefit he received from eighteen, he took forty-eight within twelve hours. So that the case, so far from constituting an exception, by its negative results confirmed our point."

It certainly does require some confidence in hypothesis to believe that the additional quantity prevented salivation. We confess that we are sceptical. Other things being the same we feel a great difficulty in crediting the homeopathic supposition that a quantity minus occasions an effect plus.

But however this may be, the facts stated by Dr. Law are by no means devoid of practical interest. Few, perhaps, supposed that a very small quantity of mercury may by management be made to produce a greater given result than a quantity much larger in different circumstances.

SHORTENING OF THE NECK OF THE THIGH BONE, INDEPENDENTLY OF FRACTURE, IN EARLY OR IN MIDDLE LIFE. BY GEORGE GULLIVER, ASSISTANT SURGEON TO THE FORCES.

In old subjects the neck of the thigh bone is well known to become in many cases shortened, and to form a less considerable angle with the shaft, so that the head of the femur sinks, and the limb is diminished in length. These changes are familiar.

But it is not generally understood that in early life, and at any period antecedent to old age, changes of a similar character may ensue, and a mere contusion of the hip may give rise to interstitial absorption and alteration of the bone, attended with shortening of the limb, and, consequently, simulating fracture. It is to establish the occurrence of such a series of changes that Mr. Gulliver has published the following cases. It must, of course, be most important to be aware of them, for a patient may be much incensed and a surgeon much disgraced, if deformity follows what the latter considered a mere contusion.

Mr. Gulliver relates four cases, but as the two first were not fatal, and afforded no positive evidence of the actual nature of the injury, we pass them over. We shall therefore confine ourselves to the third and the fourth.

Case 3. John M‘Grath, aged 30, 2d Battalion Rifle Brigade, was admitted into regimental hospital at Malta on the 30th June 1828, with a severe contusion of the right hip, from a fall over a wall twelve feet high, when drunk. No symptoms of fracture presented. He was discharged on the 7th of August following with very slight lameness, but continued to do the active duty required by his regiment, although he occasionally complained of weakness in the injured part. There was manifest protuberance of the right hip, and appearance of shortening of the limb, with an awkwardness in marching. On the 1st August 1830, he committed suicide.

On examination of the body, the neck of the thigh-bone appeared somewhat shortened, and forming nearly a right angle with its shaft, the upper part of the head being just level with the summit of the great trochanter. There was some adventitious bony matter near the trochanter at the basis of the neck, and an increase of density and thickness of the upper part of the shaft. The capsule of the joint appeared uninjured; but the round ligament had apparently been detached from the head of the bone, to which it had acquired a new connexion near to its original site.

Case 4. J. Fox, aged 32, after a service of eight years in the West Indies, died of phthisis, for which disease he had been two years under treatment in hospital. A long time after his confinement it was observed that his right inferior extremity was emaciated, but there was no note of any affection of the limb previous to his admission into hospital.

At the post mortem examination, the right inferior extremity was found, by measurement as in the preceding cases, to be at least an inch and a-half shorter than the other, and the extent between the pubis and trochanter of the affected side was diminished in a corresponding manner. The limb was much emaciated, but its position was natural, and the motions of the coxofemoral articulation were not impaired.

Having removed the upper part of the femur, Mr. G. found its neck absent. The head was flattened and expanded considerably; it was approximated to the shaft so as to be situated much below the great trochanter. A section of the part was made, when the upper and lower shell of what remained of the neck, was seen to be formed of compact bone, quite equal to the ordinary thickness in this situation, and the reticular texture of the bone was more dense for some distance from the edges, so as to form an indistinct line on either side of the most contracted part towards the centre. The cancelli were filled with caseous matter, in some places nearly colourless, in others tinged with dark grumous blood. The acetabulum was diminished in depth, but enlarged laterally, so as to correspond with the altered shape of the head of the thigh-bone. The cartilage of the articulation presented throughout its usual thickness and consistency, and was generally smooth and lubricated with synovia. Mr. G. examined the other thigh-bone, and found its form and condition in every respect natural.

Mr. G. now sought information respecting the history of the case from some of Fox's comrades who had served and come home with him. From them it appeared, that Fox had received a fall about three years before at the island of Nevis, in consequence of which he often complained of pain about the hip, but continued to do his military duty many months after, never having been confined on account of the accident.

The morbid parts described in this and the preceding case, are preserved in the museum of the Army Medical Department, to which the profession have free access through the liberal arrangements of the Director-General.

Mr. Gulliver remarks :

"The case of Fox appears to afford a well-marked instance of gradual removal of the neck of the thigh-bone in consequence of action induced in that part by injury. From the history of the case it is impossible to suppose that fracture

had occurred; and it is improbable that any considerable shortening had taken place previous to his admission into hospital for the thoracic affection, since he performed the duties of a soldier long after the accident, without any lameness apparent to his comrades. We are, therefore constrained to suppose, that the removal of the neck of the bone had been effected during his very long confinement in hospital for the pectoral disease,-a circumstance not very favourable to the recommendation by Dr. Hawkins of the horizontal posture as a remedy in such cases, and equally adverse to the opinion of those continental pathologists, who attribute this alteration in the neck of the thigh-bone to the gradual operation of the superincumbent weight of the body. But Dr. Knox has long since remarked, that it is unnecessary to have recourse to such an explanation of the cause of interstitial absorption of bone; and in the museum at Chatham this phenomenon is exhibited in the spine of a young man, in which the change took place in the recumbent posture.'

We think that these observations and cases should receive attention. Perhaps they are not yet sufficiently precise to give a satisfactory character to the deductions which appear to flow from them. But they go very far towards establishing the occurrence of interstitial absorption of the neck of the thigh-bone, as a consequence of comparatively trivial injuries at any period of life. No unimportant fact. We have already said what we think no more than due to the zeal and intelligence of Mr. Gulliver. We shall be always happy to introduce him to the notice of our readers. It is a grateful task to a man of a liberal mind to extend the hand of encouragement to merit.

CASES OF DISSECTING ANEURYSM.

1. CASE OF ANOMALOUS ANEURYSM OF THE AORTA, RESULTING FROM EFFUSION OF BLOOD BETWEEN THE LAMINE COMPOSING THE MIDDLE COAT OF THAT VESSEL. By C. W. PENNOCK, M.D.

2. ACCOUNT OF A CASE OF DISSECTING ANEURYSM SEEN AT AN EARLY STAGE. BY PAUL B. GODDARD, M.D.

Most of our readers are probably aware of what is meant by "dissecting aneurysm." It is that form of aneurysm, in which the blood becomes effused between the tunics of the artery, separating and dissecting them from one another, perhaps for a considerable distance.

A case of this kind lately occurred in the dissecting-rooms of St. George's Hospital, in Kinnerton-street. Unfortunately the parts were too much destroyed before we saw them to admit either of accurate description, or of preservation. But the internal and middle coats of the aorta had given way above the diaphragm, and a large quantity of coagulum extended, immediately beneath the external coat, as low as the bifurcation of the vessel into the common iliacs. Dissecting aneurysm is sufficiently rare to make well-attested cases of it matters of rational curiosity. And as there are probably some medical men who are unacquainted with its characters, we shall introduce the two following facts from our valued American contemporary.*

Case 1. A black woman, aged 75, entered the Philadelphia Hospital, December 20, 1835, with the following symptoms :

Countenance anxious; position in bed elevated; œdema of the legs and ankles ; pulse 90 per minute, full, tense, intermittent; slight muscular movements cause

* The American Journal of the Medical Sciences, November, 1838.

palpitations of the heart; oppression but no pain in the præcordial region. Over the region of the heart percussion is dull in a space, the outline of which corresponds to the form of the pericardium, which extends downwards from the cartilage of the third rib the length of sternum, and laterally, on a line drawn through the nipple, from one inch to the right of the middle line of sternum to the margin of left axilla. Impulse of the heart forcible; rythm nearly natural; first sound roughened, having a rasping sound strongly marked opposite the cartilages of the third rib and along the upper third of the sternum; second sound dull, somewhat prolonged.

The symptoms had commenced eight years previously. During the Summer of 1827, whilst using great muscular exertion, (pumping water,) she was seized with sudden and severe pain at the sternum, attended with violent action of the heart, and a sense of suffocation. The pain increased in violence, and after remaining fixed in front of the chest for two weeks became lancinating, extending from the sternum to the back, and was attended by a short cough. The pain continued for nearly three months, when the dyspnoea increased. This cough, and palpitation continued with varying severity, and attended with occasional cedema of the lower limbs, up to the time of her admission into hospital. We need not particularise the treatment nor the details of the case. Suffice it that the dyspnoea, &c. increased, and, on the 26th of January, the patient died. Dissection. We pass over other circumstances, to arrive at the state of the heart and the aorta.

"Heart much enlarged, more than double its natural size; right cavities more dilated than those of the left; coagula in both ventricles, especially the right. The parietes of the left ventricle measure seven-eighths of an inch in thickness, those of the right ventricle natural. The semilunar valves of the aorta partially ossified; the mitral valves opaque, thickened, with cartilaginous depositions on the free edges; semilunar valves of the pulmonary arteries and tricuspid valves, natural. The aorta is apparently much dilated, and, when cut into, presents the remarkable appearance of being a double vessel. The internal vessel is the aorta proper communicating directly with the heart, and is nearly surrounded by another vessel of much larger diameter, which, commencing opposite the great sinus of Valsalva, accompanies the aorta until it divides into the primitive iliacs and terminates in a cul de sac. The aorta communicates with the external vessel by a valvular fissure half an inch in length, with rounded edges, which penetrates through the serous and parily through the middle coats, and which is situated half an inch above the semilunar valves. The external vessel has no communication with the heart except by this opening. The innominata, subclavian, and left carotid arteries have each double orifices communicating with the aorta and external vessel. The innominata near its mouth is divided by a septum into two portions; the septum terminates in a semilunar edge half an inch above the aorta. In the left carotid the appearance of double vessels is presented for the space of two inches; each has separate openings, one communicating with the aorta, the other with the external vessel. In the left subclavian, on the contrary, there is no double vessel; the orifices opening into the aorta and external vessel being merely formed by a valvular septum at the mouth of the artery. The intercostals of the right side of the thorax communicate with the aorta, whilst those on the left open into the external vessel. The coeliac, superior and inferior mesenterics, renal, and other arteries given off in the abdomen above the bifurcation into the primitive iliacs, communicate with the aorta. The aorta is perforated by numerous foramina, by which, communication is established between it and the external vessel. Anteriorly the external vessel is composed of three coats; an outer, which is cellular; a middle, formed of muscular circular fibres, and an internal, which resembles the serous tissues, but is of variable thickness and presents various colours in different parts of its extent. The cellular coat and the lamina of muscular fibres are continued around the posterior