subsequent day; and a re-accumulation soon began to make its appearance. M. Oppenheim did not deem it proper to repeat the operation.

It is not necessary to go into the details of the other cases communicated by Professor Oppenheim: in all of them a cure was effected without much trouble or suffering to the patient. In none was the local reaction so strong as to require depletion. Most of the patients could walk about and attend to their business in three or four days; some in a shorter time. Usually all trace of the complaint disappeared within three or four weeks; in some within a shorter time, and in a few not for two weeks more.

The results of the practice have been so favourable that M. Oppenheim now uniformly adopts it in all cases of simple and uncomplicated hydrocele. It is probably from having used it in unadvisable cases, that some surgeons have reported so unfavourably of the iodine injections.

The tincture used by M. Oppenheim is prepared with 48 grains of the iodine to one ounce of alcohol. As a precipitate is speedily formed when this tincture is mixed with water, the injection should not be prepared until the moment of the operation.

With respect to the length of time that the solution should remain in the sac, this must depend altogether on the accession and severity of the pain along the cord, that may be induced. The injection is to be used tepid, as the iodine remains longer in solution, than when cold water is used.

Such is the substance of Oppenheim's report, which is highly favorable to the use of the iodine injections. Let us now attend to the statements of M. Fricke, who has tried the practice and has found it, he tells us, altogether objectionable. We shall allude briefly to his cases first, and then make a remark or two on the discrepancy between the reports of these two eminent practitioners.

The first case occurred in a young man, twenty-five years of age. There was a double hydrocele; and the complaint had existed for eleven years. M. Fricke considered that there was no disease of the testicle, nor any other complication. On the 26th Dec., the right sac was punctured, and then filled with about six drachms of a warm solution of iodine, prepared with two drachms of tincture of iodine and six ounces of distilled water. Very little local reaction followed the operation; and, by the 2nd January, the scrotum had regained its former size, and a fresh accumulation of fluid had taken place.

Four days subsequently-viz. on the 6th of January, the iodine injection was repeated. The fluid did not flow out readily, but required to be pressed out by stroking the testicle. From this circumstance M. Fricke concluded, that partial adhesion of the opposite surfaces of the tunica vaginalis had already taken place. The consequences of this second operation were most distressing. Violent fever set in, and the scrotum became first inflamed, and then partially sphacelated. A large portion of the integuments and cellular substance sloughed off; and for some time the patient was in an alarming state. Ultimately however he did well, and the hydrocele on each side was effectually removed.

The second case occurred in a man twenty-seven years of age. The hydrocele had followed a contusion of the testicle, and was of about six months' standing. After the fluid was discharged, a weak iodine solution, of the same strength as what was used in the former case, was injected. It proved quite ineffectual; and as the fluid re-accumulated in the sac, the operation by incision was now resorted to, and proved successful.

The third case was that of a youth, 19 years of age. The iodine injection speedily effected a cure.

In the fourth case-which occurred in a man 28 years old, and was of about six or seven months' standing-a stronger solution of iodine, (viz. one part of

iodine tincture and three-parts of cold water), was used. Every thing went on well till the eighth day; and then the spermatic cord of the affected side began toswell. The swelling was followed by suppuration, which seriously retarded the recovery. Ultimately the case did quite well, and the hydrocele was got rid of.

The fifth case occurred in a man 42 years of age. The hydrocele was of only three weeks' standing, and did not exceed in size a hen's egg. The stronger solution of iodine-one part of the tincture and three of cold water-was used. Very trifling local reaction followed the operation. The effusion re-accumulated; and ultimately the radical operation by incision was performed.

Sixth Case.-A youth, 22 years old, had been affected with a double hydrocele for about four years. The stronger solution of the iodine was injected. The result was entirely successful on the right, and partially so on the left, side. From the consideration of these cases M. Fricke is not disposed to report very favourably of the iodine injection.

He subsequently relates three cases in which he employed ice-cold water as an injection with complete success; but, on the whole, he seems to give a decided preference to the radical cure by incision, to the use of any sort of injection.-Zeitschrift fur die Gesammte Medicin.

Remarks. It will be observed that the practice of Drs. Oppenheim and Fricke differs considerably in several points.

The impression is certainly left on our minds that the latter gentleman did not attend, in all respects, to the niceties of the operation-we mean, for example, the selection of the appropriate cases, the employment of an injection of due strength and of a proper temperature, &c. It is possible,-nay probable from the history of the case-that in the first patient the testicle was, if not positively diseased, at least highly irritable and disposed to take on a morbid action. May we not infer this from the circumstance of the hydrocele having come on at eleven years of age and having continued for 8 or 9 years? Remarks might be made on some of the other cases too, reported by M. Fricke; but this we deem unnecessary, as we prefer leaving our readers to compare facts, submitted to their attention, for themselves, and drawing their own inference from them, rather than obtruding our own personal opinion.-Rev.

ON THE TREATMENT OF HYDROCELE WITH IODINE INJECTIONS IN THE EAST INDIES.

The following statements are from the pen of M. Dujat, who has, he informs us, recently returned from Calcutta.

Hydrocele is a disease of great frequency in the East Indies, among both the European residents, and the native inhabitants. Before the important discovery of Mr. Martin in 1832, of the efficacy of an iodine solution as an injection into the tunica vaginalis, the native inhabitants were unwilling to submit to any radical treatment, whether by the use of injections of port wine, &c. or by in cision. The tediousness, as well as the severe pain, of the treatment deterred them from having anything done more than simple puncture of the swelling; and even this they often objected to, preferring to allow the hydrocele to increase to an enormous size.

It seems however that, since the year 1832, the number of patients treated in the native hospital alone at Calcutta has been very great annually. From January 1836 to Jan. 1838, 1,000 patients were admitted with hydrocele, and

all of them were treated with the iodine injection. The ages of these varied from 18 to 70 years of age. The disease seems to be most frequent between the ages of 25 and 35 years. In 305 cases the hydrocele was on the right, and in 325 it was on the left, side: in the remaining 370 cases the hydrocele was double, or on both sides. The quantity of serum evacuated varied from less than ten to upwards of 100 ounces.

Of the 630 cases of single hydrocele, in rather more than one third of the whole number the quantity of serum was under ten ounces; in two-sevenths it was from 10 to 20 ounces; in nearly a third it was from 20 to 50 ounces; and in eighteen cases it was from 50 to 120 ounces.

The practice recommended by Mr. Martin, and which M. Dujat saw employed in an immense number of cases, is as follows. After the serum has been discharged, the iodine solution* is injected; and, immediately afterwards, both the canula and the syringe are removed at once, as the solution is almost always left within the sac. The surgeon then works the scrotum about in his hand, so as to bring the solution in contact with every part of the tunica vaginalis. The after-treatment consists in merely applying compresses wet with Goulard lotion to the testicle, and in administering a purgative.

The patients usually walk home immediately after the operation, and return the next day or two to the consultation.

On the second day there is, in most cases, a slight febrile reaction, and the testicle is swollen and tender.

Many patients complain for several days of a coppery taste in their mouths, and that all food is quite insipid. Some patients return to their usual occupations on the following, but most on the third or fourth, day after the operation. In a very few cases, the subsequent inflammation was rather de trop; but it was readily dissipated by the use of leeches, and of febrifuge medicines.

The number of failures in the 1,000 cases was extremely small; only once among the cases of single hydrocele, and only six times among those where the hydrocele was double or on both sides; and in all these last there was partial success, at least on one side. The cause of the failure was attributable either to the scrotum being affected with elephantiasis, or to the tunica vaginalis being indurated or otherwise morbid.

As some of the patients did not return after the operation, it may possibly have failed in a few of them: but this is conjectural. So satisfied are the Indian practitioners of the superiority of Mr. Martin's practice over any other, that it is now almost universally adopted.-Gazette Medicale, 1838.

Remarks. Our readers will not fail to compare the eminently successful practice recommended by Mr. Martin, who first introduced the use of iodine injections in the treatment of hydrocele, with that of Drs. Oppenheim and Fricke, mentioned in the preceding article.

The success of Mr. Martin has indeed been very extraordinary; and it is right to observe that his practice has been tried by M. Velpeau, who reports most favourably of it. (Vide the Foreign Periscope of this Review for April, 1838.)-Rev.

Mr. Martin uses in almost all cases a solution of the same strength, viz. one part of the tincture (according to Magendie's formula) and three parts of water. The quantity however to be injected varies from a drachm and a half to five drachms of the mixture, according to the size of the hydrocele. The peculiarity of Mr. Martin's practice consists in using only a very small quantity of injection, and in leaving this within the sac to be absorbed by nature afterwards.

TREATMENT OF PROLAPSUS UTERI BY PARTIAL SUTURE OF THE VULVA.

Case 1.-A woman, 43 years of age, was admitted into the infirmary at Hamburg in March 1837. Fifteen months before she had been cured of a prolapsus uteri by means of the operation of Episiorraphy-or suture of the posterior commissure of the vulva. Subsequently she had become pregnant; and as, during labour, the band of junction between the two labia appeared to oppose the delivery of the child, the accoucheur divided it across.

The consequence of this was that the prolapsus returned; and it was for the relief of this complaint that she again sought the assistance of Dr. Fricke.

The operation of Episiorraphy was again performed, by excising a narrow longitudinal strip of the mucous membrane of the lacerated vagina on each side, and uniting the opposed raw surfaces together by means of two or three sutures. Although the anterior and posterior ends of the wounded surfaces did not adhere, the extent of junction was quite sufficient to prevent the exit of the prolapsed uterus; and the patient left the hospital, in about six weeks after the operation, relieved of her troublesome complaint.

Case 2.-A woman, 41 years of age, was admitted into the infirmary on the 6th of July 1837. She reported that, six years previously, she was delivered by means of the forceps of a child, and that ever since that time she had been afflicted with a prolapsus of the uterus. The protrusion was so large, and gave so much distress, that she had been long prevented from engaging in any employment. The exposed surface of the vagina and of the cervix uteri had become dry and leathery, and was here and there excoriated and ulcerated. A constant discharge exsuded from the prolapsed parts.

After soothing and astringent means had been used for some time, in order to allay the irritation and swelling, the operation of Episiorraphy was performed on the 22nd of August. The commissure of the labia extended back almost to the edge of the anus; but they, the labia, were still of sufficient breadth to permit a strip of skin to be detached from them.

As it had been repeatedly observed that, in order to prevent the protrusion of the uterus and vagina, it was not absolutely necessary that the whole extent of the cleft should be made to adhere, the posterior part, or that next to the anus, was left open at present, and only the anterior part was stitched together. When the united part had cicatrised, the tendency to prolapsus was found to be completely removed, and the patient could walk about without any fear of its return. An opening between the edge of the anus and the posterior edge of the artificial commissure continued; but, as this was attended with no inconvenience, Dr. Fricke saw no propriety in doing more. Indeed he has reason to believe, from the result of this and of some other cases, that it is much better for the surgeon not to attempt the junction of the whole extent of the cleft, and that he should rather follow the practice of leaving an ununited part posteriorly-through which the menstrual secretion, &c. may find a ready exit-as adopted in the preceding case.-Zeitschrift fur die ges: Med.

DUPUYTREN'S POMMADE AGAINST THE FALLING-OFF OF THE HAIR.

The part that is bald, or is likely soon to be so, is to be rubbed with a portion of this pommade every evening.-Journal de Pharmacie.

DUBOIS' RULES FOR THE TREATMENT OF UTERINE HÆMORRHAGE.

Before Labour. A.-If the hæmorrhage be inconsiderable, the following simple means may be sufficient—a horizontal posture; perfect quietude; cool air; cool acidulated drinks; evacuation of the bladder and rectum; and, if the patient be plethoric, the abstraction of a small quantity of blood from the arm.

If the hæmorrhage be serious, we should first have recourse to the means now mentioned, excepting perhaps that of bleeding. Should they fail, the application of cold lotions to the hypogastrium and the inside of the thighs is often serviceable; if this is insufficient, the ergot of rye* (36 grains in three doses, given at intervals of ten minutes) should be administered; and, should the hæmorrhage still continue, we must then resort to the use of the plug.†

During Labour.-When the hæmorrhage is inconsiderable, and when, at the same time, the orifice of the uterus is not dilated, and the membranes are entire, the same means recommended at A-except the blood-letting which is very rarely necessary, should be used. If the orifice is dilated, and the membranes are still entire, it will be found useful in many cases to rupture these, should the hæmorrhage continue: if the membranes are however broken, the ergot of rye is frequently useful.

When the hæmorrhage is serious, and the mouth of the uterus is still undilated, we are first to have recourse to the various means recommended above, including the use of cold applications to the hypogastrium, and of the ergot of rye. Should however all these means fail, we should then rupture the membranes, if this can be easily done; but if not, we must trust to the plug, or proceed to extract the child either by turning or by the forceps. It is always better to trust to the efforts of Nature to expel the child, than to have recourse to manual delivery; and in most cases of hæmorrhage, except when the placenta is implanted over the orifice and neck of the uterus, this will be effected under judicious management. Even in reference to the case, where the placenta is implanted at the uterine orifice, it sometimes happens that it does not cover it completely, and that the bag of the membranes will protrude at its side, and the labour will be completed without having recourse to turning the child.

When however it is necessary to perform this operation, the fingers should be passed up between the parietes of the womb and the adhering side of the placenta, so as to detach it from its connexion, and not, as many accoucheurs recom

It is very doubtful that the hæmostatic property of this medicine depends upon its exciting the uterus to contract. It seems only to increase uterine contractions when they exist, but not to induce or bring them on, when absent.

†The operation of the plug is twofold: it first stops the hæmorrhage; and then, by its presence in the vagina, it excites the uterus to contractions, by which its orifice becomes dilated. When this takes place, we may either rupture the membranes, or allow labour to advance, according to the circumstances of the case.

M. Dubois very properly points at the necessity of great attention, and of frequent examination both of the abdomen, and also, but more seldom, of the vagina, when a plug is used to arrest a serious uterine hæmorrhage. Many women have perished from internal hæmorrhage, when not a drop of blood flowed outwardly. The danger of such an occurrence is always greater when the labourpains are weak than when they are forcible.