permitted a very free communication between the two ventricles.—Archives Generales.

IRREGULARITIES OF THE SUBCLAVIAN ARTERY AND VEIN.

The following case will illustrate what unexpected difficulties may arise in a case, where it is necessary to tie the subclavian artery.

A soldier received a stab in the axilla: a profuse hæmorrhage followed; and, although it seemed to be checked by pressure, Professor Dubreil did not hesitate at once to proceed to tie the subclavian artery. After the necessary incisions had been made, he felt for the tubercle of the first rib, and expected to find the artery where it emerges from between the scaleni muscles. But instead of the artery, the subclavian vein was in its place; and, as the wound was constantly filled with dark blood, he found it impracticable to search for the artery. He therefore determined, without loss of time, at once to tie the axillary artery between the deltoid and pectoral muscles. The patient died on the following day. Dissection. On examining the wound it was found that the brachial artery, close to the point of its origin, had been penetrated. The ligature included the axillary artery alone, and none of the nerves were in any way injured. tracing the subclavian vessels, the vein was found occupying the usual position of the artery between the anterior and middle scaleni muscles: it (the latter) was situated somewhat in front of and above the nerves, and was not easily exposed even in the dead subject. The distribution of the vessels on the left side was altogether normal.

On

The arterial irregularity, observed in the preceding case, has been noticed by several surgeons. Thus Velpeau and Blandin mention a case where the subclavian vein accompanied the artery between the scaleni muscles. Cruveilhier found both vessels situated in front of the anterior scalenus muscle, and in another case the middle scalenus passed between and separated the leash of the axillary nerves. Many other cases might be alluded to; but this is unnecessary.

The operating surgeon cannot be too well acquainted with all these irregularities in the distribution and relative arrangement of the great vascular trunks. -Gazette Medicale.

PROPESSOR DIEFFENBACH ON THE ORTHOPEDIC ESTABLISHMENTS IN PARIS. The great progress, which Orthopædy has made of late years in France, has attracted the attention of most recent professional visitors to Paris. Indeed, after lithotrity, the treatment of deformities and contractions has become quite a favourite subject with many of the leading surgeons in that metropolis. Not many years ago, the management of such cases was not deemed worthy of the surgeon's attention; and it was therefore left to corset makers, and to others equally as uninformed, to do the best that they could to rectify, or at all events to conceal, the deformity. But now there are regular establishments, conducted by most able and intelligent men of education, in the neighbourhood of Paris, to which resort, from all parts of France, an immense number of persons who are afflicted with curvatures of the spine, contractions of the limbs and such-like maladies. The most celebrated of these are situated at Passy, a beautiful village in the immediate neighbourhood of Paris, and belong to M. Guerin, and to M. Bouvier. Both institutions are conducted with admirable skill, and afford to the invalids every advantage which the ingenuity and experience of these gentlemen can afford. The arrangements for gymnastic exercises, for the use of extending machinery and bandages, for the improvement of the general health of

the patients, and at the same time for the recreation and instruction of the mind, are most complete in every particular.

In cases of curved spine, the extension is effected by means of a peculiarly constructed bed to which the patient is secured, and the length of which may then be increased or diminished as the surgeon may require. The one used and recommended by M. Guerin consists of four different segments or smaller beds, which can be separated from each other or screwed together at pleasure. By moving one or more of the pieces to either side, after the patient has been secured by the bandages and straps, a certain lateral direction may be given to the extending force, so as to draw the spine either to the right or to the left hand, according to the inclination of the curvature. The peculiarity of M. Guerin's extending bed is its being composed of several distinct pieces. The entire establishment of this gentlemn at Passy deserves the highest praise. The great Monthyon prize was some years ago awarded to him by the Royal Academy at Paris, for the various improvements which he had introduced into the scientific practice of Orthopædy. His museum contains numerous specimens of comparative as well as human anatomy, and also a most instructive collection of Parisplaster casts of the various forms of distortion and irregularity of the spine and joints, at various periods of their treatment.

The employment of gymnastic exercises holds a prominent place in the Orthopædic practice of M. Guerin. In the great hall of his establishment are to be seen all sorts of machines and apparatuses for the use of the inmates. Swim. ming and other exercises, in which the body lies as in swimming, are particularly recommended both by M. Guerin and by M. Bouvier. Another exercise, which is very generally practised by young invalids, is going on tall crutches. "I was," says Professor Dieffenbach, "quite astonished, upon entering the gardens, to see a number of French girls moving about with surprising agility on tall crutches, like so many kangaroos with their short arms and long legs.' The staves of the crutches are very tall, so that when the invalids stop, their feet do not touch the ground, but are suspended, schwebend in der luft, half an ell above it, and the body is supported by the arms.

Professor Dieffenbach seems to approve of this mode of exercise, and recommends it to his countrymen for imitation. He mentions with praise the collection of casts and other illustrative preparations in the museum of M. Bouvier, and alludes in particular to one cast, which M. Bouvier directed his attention to, as being quite une moule historique." Its history is rather curious and may be instructive as well as interesting to the reader.

An orthopædist of some eminence in Paris announced, some time ago, to the Institute of France, that he had discovered a method of removing curvatures of the spine in a very short period of time; and, with the view of convincing the members of the truth of his claim, he brought before their notice a young woman in whom there was a very marked irregularity of the spine, which he undertook to rectify in the course of a few weeks. A commission was appointed to investigate the subject; Paris- plaster casts were taken of the patient's back; and every other means to arrive at the truth were adopted.

Within a very short time, the girl was again presented before the Institute, and now not the slightest trace of deformity was visible. The commissioners were quite satisfied of the identity of the individual, and could not help expressing their astonishment at the extraordinary rapidity of the cure: it seemed to them quite miraculous. M. Guerin however suspected that there must be some deception, and that the case was in all probability one of simulation.

He soon convinced the commissioners of the truth of his suspicions, by proving to them that, although the line of the spinal column seemed to be quite as much deformed in the simulated as in the genuine case of the disease, the muscles of the back were at the same time dislocated in the latter, but not in the former, instance. By attending therefore to the condition of the spinal muscles in a sus

pected case, we may generally detect when a fraud is attempted to be played upon our judgment.

The zeal, with which M. Guerin exposed the impudence of the above trick, so irritated the impostor that he brought an action at law against his adversary; and, although all right and equity were on the side of M. Guerin, he was amerced in a heavy penalty for the injury he had done to the plaintiff's character.

Professor Dieffenbach pays a high compliment of admiration to M. Bouvier for the pleasure and instruction he had received from visiting his orthopaedic establishment; and he alludes with great satisfaction to his having met there some of the ablest professional men in Paris, such as the two Larreys, father and son, Marjolin, Le-roy, and many others. The second prize of 2000 francs has been awarded by the Institute to M. Bouvier for the various improvements which he has introduced.

For some time past, he has had the charge of all cases of deformity in the Hôtel Dieu, and also in the Hôpital des Enfans Malades; and at these two great institutions, the medical students have an opportunity of acquiring a scientific knowledge of Orthopædy.

Besides the establishments noticed above, there has been for some time a sort of ambulatory infirmary for the treatment of deformities, in Paris; this is under the management of MM. Bouvier and Duval. At a stated hour each day a great number of cases, among children chiefly, come for advice, bandages, and so forth-all which are given gratuitously.

M. Duval attends to the cases of club-foot, and M. Bouvier to those of spinal deformity. In lateral curvatures of the back among the poor, and those who cannot be treated at home with the extending bed, M. Bouvier employs the girdle or cincture invented by M. Hossard (ceinture à levier ou inclinatoire), by means of which the depressed shoulder is elevated, and the spine is inclined somewhat over to the side opposite to that of the curvature.

Many of the cases of club-foot are treated by section of the tendo-Achillis, as recommended by M. Stromeyer.-Zeitschrift fur die ges: Med.

CONCOURS FOR THE CHAIR OF ORGANIC CHEMISTRY AT PARIS.

The following brief notice of the tests to which the rival candidates were submitted, at the late concours for the chair of organic chemistry and pharmacology will possibly be interesting to the English reader. The election by concours may, we will allow, be attended with some disadvantages, as it has been often remarked that professional and scientific men are generally the least impartial judges of professional and scientific merit; but that there are corresponding and, we may add, overbalancing benefits from its adoption, cannot be well disputed.

The first examination was altogether occupied with the preparing of a written thesis upon the organic alkalis.

At the second examination, the candidates had to discourse orally, after twentyfour hours' preparation, upon a given subject. M. Baudrimont upon the chemical and pharmaceutical relations of alcohol; M. Bouchardat upon those of the essential oils; M. Bussy upon those of adipose and fatty matters; and M. Dumas. upon those of sugar.

At the third examination—which also was an oral one, after two hours' preparation, upon a subject determined by lot-MM. Baudrimont and Bouchardat had to treat of the properties of albumen and gelatine, and MM. Bussy and Dumas upon those of milk.

At the fourth and last examination, the candidates were required to defend their respective printed theses. M. Bussy on the urine and its changes in diseases; M. Dumas upon the influence of heat on organic bodies, and its employ

ment in pharmaceutical preparations; M. Bouchardat on the blood; and M. Baudrimont on the present state of organic chemistry.

Each candidate gave convincing proof of great knowledge and acquirements; but as the superiority of M. Dumas was acknowledged by all, he was unanimously elected to the professional chair.

TREATMENT OF DIPTHERITE, OR CROUPY INFLAMMATION OF THE MOUTH.

Dr. Ruppius, of Freiburg, very justly remarks, that the morbid action or process in this disease-first accurately described by M. Bretonneau of Tours-is essentially the same as characterises the well-known disease of Croup or Cynanche Trachealis. In both, the inflammation of the affected mucous tissue has a very marked tendency to cause an exsudation of a membraniform lymph on its surface in the one, this phenomenon is usually limited to the trachea and lower part of the larynx; while in the other, it is observed chiefly on the velum palati, the tonsils, and back parts of the fauces.

Diptherite usually commences with the ordinary symptoms of Cynanche. There is some difficulty experienced in deglutition, arising from the swelling of the tonsils; the act of inspiration is attended with a slight snoring noise; the voice becomes sharper and shriller; and the system is generally more or less feverish. If the fauces be examined, the surface, especially that of the tonsils and uvula, is observed to be of a purplish red colour.

When the exsudation commences, a troublesome cough is apt to come on, the breathing becomes more and more difficult, and the patient is more restless and agitated. If the morbid action extends to the opening of the larynx, the symptoms become much more alarming, and the local distress assumes much the same character as is present in croup. Such cases usually prove fatal.

The treatment of this disease is to be conducted on the same principles as that of croup-bloodletting, local and general, in the early stages, and the use of calomel and of antimonials in such doses as to make an impression on the system. Along with the adoption of these means, Dr. Ruppius strongly recommends the local application of the nitrate of silver to all the parts of the fauces, which are not invested with the exsuded lymph. The marked efficacy of this treatment, in arresting and in modifying the morbid action, is often very gratifying. There is no objection to the applying the nitrate to the parts which are covered with the lymph; but it seems to be generally useless.-Zeitschrift fur die ges. Med.

PROFESSOR OSIANDER ON PUERPERAL FEVER.

Professor Osiander premises his remarks, by observing, that the term 'Puerperal, or Child-bed Fever,'-although not scientific, nor consonant to the nomenclature of other febrile diseases-cannot be well replaced by any other which has been proposed, such as peritonitis puerperalis, metro-peritonitis, &c. The peri toneum and the uterus may be quite free from inflammation, and yet the patient may die from puerperal fever.

Often the disease commences as an attack of meningitis, or of erysipelas, or of rheumatic swelling of the joints, &c. and, under any of these forms, it speedily proves as dangerous and alarming as when the uterus and peritoneum are primarily affected. For this reason, Professor Osiander prefers to retain the old generic term of Puerperal fever, and of distinguishing its various species or forms in the following manner, according to the seat and character of the predominant local mischief.

The last-mentioned variety includes, according to this tabular arrangement, all those cases of child-bed fever, in which there is a suppurative inflammation of the uterine and adjacent veins. It is by far the most formidable variety of the disease, and is that which usually prevails epidemically at certain seasons, more especially in large institutions. To apply the term peritonitis or metroperitonitis to it, is not only quite incorrect-seeing that often no genuine traces of peritoneal inflammation are discoverable on dissection-but is likewise most seriously hurtful, in consequence of the erroneous treatment which will necessarily be recommended.

An impure condition of the atmosphere-attributable very often to an overcrowded state of the wards in a lying-in establishment-is unquestionably one of the most frequent causes of puerperal typhus. That this form of the disease is of a miasmatic origin, and is communicable from one patient to another, cannot be well disputed; and it therefore becomes the duty of the physician and nurse to use all precautionary means to prevent the dissemination of the miasm, by changing their own garments frequently, washing their hands, &c. as well as by the employment of fumigations and other well-known means.

Much may be done in the way of prophylaxis of this disease, but very little in the treatment of it, when it is once fairly established. There is perhaps no form of fever so little under the control of medicine as puerperal fever: it is only in the precursory and very early stages of the disease that the healing art can be of any avail.

According to the researches of Osiander, inflammation and suppuration of the uterine veins is by no means so generally present, as some authors might lead us to suppose.

Inflammation of the lymphatic vessels seems to be of much more frequent occurrence when the peritoneum has been inflamed, than phlebitis of the uterine veins.

The latter is however by far the most serious affection of the two. Abscesses of the liver, of the lungs, and of the muscles and joints, are not uncommon sequela of uterine phlebitis, when the patient has survived the early stage of the disease.

The following few cases illustrate some of the most generally observed characters of puerperal typhus.

CASE 1.-Puerperal Typhus, fatal in 24 hours, with Peritonitis, and Suppuration in the Uterine Lymphatics.

A woman, 27 years of age, was delivered in the Maternité Hospital, at a time when child-bed fever was very prevalent. For three days subsequently she went on very well; but, on the fourth day, she began to complain of pain in the hypogastric region. The pulse, at this time, was frequent, but not full or hard; and the patient was troubled with diarrhoea and tendency to vomiting. An unfavourable prognosis was formed, in consequence of the great frequency