practice, becoming daily more general, of publishing the Transactions of Societies, the interesting cases that occur in public institutions, and the documents in the possession of public boards. In such publications there are fewer inducements to distort facts, to magnify success, or conceal failures, and therefore we can place more reliance on what is offered us, than, unfortunately we can always venture to extend to more private statements. We there fore beg to offer our meed of approbation of the plan pursued in the present instance by the Madras Board.

We are tempted to notice some cases of phlebitis offered as illustrative of a mode of treatment by an operation, practised by the late surgeon Thomas Bond, of the Madras European Regi

ment.

CASE 1.—Phlebitis—fatal. J.R. private, æt. 39, 14 years resident in India, was admitted into hospital January 27, 1827, with symptoms of spasmodic asthma, &c., for which he was bled in the right cephalic vein, and took mercury to ptyalism. On Feb. 2, he complained of the arm being very painful it was much inflamed round the joint, very tender to the touch, and a drop or two of matter exuded from the orifice on pressure. Thirty leeches and a poultice were applied, and next day it was still swelled, but without pain; he looked very anxious and salsallow. He was allowed some port wine. In the evening he had an opiate followed by some aperient medicine. He vomited after the medicine, and next morning the arm was much swelled and very painful, and his countenance was worse. He was ordered camphor, and the leeches were repeated. On the 5th the swelling was extending up the shoulder, the puncture closed. We may mention that the cellular membrane appeared more affected than the vein, and in the evening of the 6th the swelling and tension were greatest at the inner side of the arm and not in the course of the vein. The treatment consisted in mild aperients, opiates, and baths. On the 7th he was delirious, the pulse 86 and very weak, the counte

nance extremely anxious. In the evening he was more delirious, the pulse 130, the skin hot. On the 8th we find him with low muttering delirium, countenance deadly, pulse 100, tongue discoloured.' Ordered quina and wine and water—a blister to the spine. The arm was scarcely larger than the other. He sank and expired at 2 A. M. of the 11th.

Sectio Cadaveris. "Coagulable lymph was thrown out in the cellular membrane. The integuments around the wound adhering strongly together, and to the wound in the vein. The vein quite closed. The vein was laid open and found to be thickened, and full of pus, up to the insertion of the deltoid muscle, from which place it was empty and sound. The abdominal viscera, heart, and the lungs, were healthy; but the latter adhered to the pleura costalis, by old adhesion."

In perusing the foregoing case we cannot but be struck with the vacitlating treatment pursued. The patient is leeched on the 2nd, ordered port wine on the 3d, camphor and leeches on the 4th, and so on. However, those who have seen many cases of phlebitis will probably be most charitable in judging of treatment.

CASE 2.-Phlebitis after Venesection -Operation-recovery.

Ensign H. æt. 19, resident in India one year, was bled to syncope (ijss) in the night of Feb. 14, 1827, for dysenteric symptoms. He used the arm much in the night, and the bandage came off. The night of the 15th was very restless, he vomited frequently, and had much heat of skin and headache, with furred tongue, pulse 120. The arm was painful, but not swelled, there was a little redness round the puncture, and on pressing around it with a sponge a small quantity of pus and blood was discharged. He had taken since the 14th a scruple of calomel, and two of blue pill. Wound closed with sticking plaister*—cold lo

This we think decidedly bad practice. A light poultice should have been applied.—Rev.

tion—and purgative medicine. At 2P.M. the arm was more painful—skin hot and dry-had vomited-more pus pressed from puncture. In the evening 18 leeches were applied and afterwards a compress was put on four inches above the puncture. Calomel and opiumsalines with laudanum and antimonybath. On the 17th the arm was more swollen below the compress. There was little alteration till noon of the 18th, when there was increased heat of skin, the arm was more painful and swollen towards the compress, and more matter was pressed from the wound by drawing the finger down the vein, from the compress to the puncture. At 3 P. M. the vein was swelled up to the shoulder, with great constitutional irritation. The following operation was performed.

"An incision was made with a scalpel through the integuments, and the median basilic vein exposed, a director was then introduced through the puncture, and, with a probe-pointed bistoury, the opening was extended above and below as far as there was any appearance of pus, which was carefully extracted by pressure, and the wound closed in the usual manner. The application of the compress was continued till the 22d in the morning."

In

About Zij. or Ziij. of pus were evacuated, and the wound was dressed with a resino-terebinthinate ointment. the course of half an hour the constitutional irritation had remarkably subsided, and the countenance, previously extremely anxious, was more composed. The same plan of treatment was persevered in, the patient taking a calomel and opium pill at night, with a diaphoretic opiate, and aperients. On the 19th, he was ordered quina, arrow-root with wine, and camphor. On the 20th he was improving, the arm was dressed and better: it discharged freely. In the evening he was worse, the pulse being much quickened, with pain in the chest. Calomel and opium and an anodyne. After the increase of heat perspiration occurred, and in point of fact there was a paroxysm of fever, though without any perceptible rigor. Next day he was better, but had a

slight cough. We need not pursue the details. On the 24th the arm was well, and some derangement of the hepatic function with a slight cough was his sole complaint. He soon perfectly recovered.

CASE 3.-Phlebitis after Venesection -Operation-Recovery.

John Palmer, private, æt. 24, resident in India two months, was admitted, March 16th, 1827, with acute hepatitis, for which bij. of blood were taken from the right cephalic vein. The treatment for inflammation of the liver was continued; but, on the evening of the 18th, he complained of pain in the arm, which was swollen, and the vein was found inflamed-pulse 100-headache. On the next morning he was free from fever, but the arm was as be fore. A compress and bandage placed on the vein, above the puncture, and the whole arm laid on a soft poultice. In the evening the arm was more painful and swollen, the inflammation reaching as high as the compress, though no pus appeared at the puncture-pulse 100-headache-fever-anxious countenance. Calomel c. Pulv. antim. et Op-Buln. He passed a feverish night, but next day he was cool, with furred tongue and anxious countenance; a little pus could be pressed from the wound.

"An incision extending from one inch below, to one inch above, the puncture, was made into the vein; its coats were found to be much thickened, its cavity larger than natural (on ac count of the compress placed on it above), and containing from about two, to three, drachms of pus. The infiammation does not extend beyond the compress; but a little pus was pressed from the portion of vein next the hand. The wound was dressed with ungt. resin. flav, with a little oil of turpentine added to it. The arm again placed in a poultice."

He was ordered quinine, and under its exhibition, with occasional purgatives, no further unfavourable symptoms occurred. On the 23d, he is reported as getting rapidly well, and in a few days the arm healed.

CASE 4.-Phlebitis after Venesection, fatal-Pus in the deeper Veins.

T. H. private, æt. 22, in India five months, admitted June 27th, 1827, with feverishness and headache. The median basilic vein was opened, but, not bleed. ing freely, the cephalic in the same arm was cut, and Hj. of blood extracted, with relief. He was leeched thrice, and appeared to be doing well, till the morning of the 30th, when the arm was painful; both punctures were inflamed, but the inflammation appeared to extend up the cephalic vein, and not up the basilic. A pad and bandage were applied about the centre of the arm, and cold lotion used. In the evening the arm was worse, with fever. The cephalic vein was laid open as in the former cases, and Zij. of pus discharged from it, a little being pressed out of the median basilic, and a little from the puncture in the basilic. The arm was laid in a poultice; the treatment much as in the former cases. On July 1st, he seemed better, a little matter oozed out at the puncture in the median basilic, without apparent inflammation; the gums were tender. On the 3d, we find no pain or inflammation in the arm, the wound suppurating and look ing well. Ordered quinine and wine in arrow-root. On the 5th he had pain across the pit of the stomach, and leeches were applied. In the evening, he had that all-but-fatal symptom in such cases, severe rigors and fever. Next day he looked ill, his appearance indicating mischief, though the arm shewed nothing amiss. The median basilic vein was laid open, and found to have a black appearance. In the evening of the 7th he had another attack of fever; and, on the 8th, he said he felt better,

though he did not look so," a very characteristic symptom. He gradually sank, and died at 7, p.m. of the 11th.

On dissection, the veins which had been operated on looked healthy, but the deep-seated veins, especially the brachial, were found full of pus. No mention is made of the state of the liver or lungs.

We have analysed these cases, because we think they inculcate an important point of practice, that of laying

open freely an inflamed and suppurating vein. The secondary consequences of phlebitis, as of other injuries, are most frequently observed when matter is locked up or does not freely escape. It is on this account that diffuse inflammation of the cellular membrane, between muscles, is so much more frequently followed by visceral deposites, than diffuse inflammation of the subcutaneous cellular tissue. We do not place much confidence on the employment of pressure by a pad; on the contrary we are tempted to believe that it is injurious, by the mechanical obstruction offered to the circulation of the limb. Every surgeon is aware how much any ligature, or compression on an inflamed limb, interferes with the natural processes of reparation. We suspect, from the manner in which the foregoing cases are drawn up, that the reporters are not aware of all that has been done in the investigation of the secondary inflammations. Thus, in the last case, we are informed, after the occurrence of rigors, that "the arm does not seem to be at all connected with his ill-health, but the disease to be in the liver, in the bowels." No surgeon who had seen many cases of the purulent depôts would make such a remark. However, we again beg to draw particular attention to the practice employed in some of these cases, and to advocate most warmly the free opening of inflamed veins, when the surgeon has reason to believe that they contain pus, which does not escape with the utmost freedom and facility.

XLVIII. CHOLERA.

We have lately dedicated so much of our space to cholera, that both ourselves and our readers must be somewhat sick of it. If we say little at present, it is because there is really little to say-little, at least, that is new. It is true that every day brings a fresh specific; yet, strange to tell, the lying cholera-list shews no alteration in the relative proportion of recoveries and

deaths. There must surely be something rotten in the state of Denmark, when, out of the multitude of certain, or nearly certain remedies, from the tincture of the Russian Merchant on Cornhill to the salts of Dr. Stevens, none have yet effected, what all pretend to effect, a diminution in the gross mortality. Amidst the variety of remedies presented to our notice, we feel like a hungry guest with a splendid bill of fare-each article tempts, but which shall he prefer? One gentleman cures cholera with cold water-another removes it with hot-a third puts it to flight with calomel and opium-a fourth exclaims that calomel and opium are poison, and drenches with salt watera fifth declaims against the absurdity of salines by the mouth, and throws them into the veins a sixth-but why should we go on? It is enough that all are sanguine, all successful, all full of cases confirmatory of their statements; yet, notwithstanding, the cholera kills as many as if all the projectors, and all the schemes, were still in the wombs of the journals.

With our boasted civilization and intellect, we walk the same mill-horse round we have walked before, and that others have walked before us. When cholera appeared in Hindostan, the papers so teemed with specifics and cures, that the Government put a stop to their further publication, on account of the mortality they caused. Our Government has not the power to do this; and we may thank our forefathers that, in this happy country, any one may cure himself to death as he pleases. Gentlemen are at liberty to publish their miracles, and the faithful are equally at liberty to believe them. For our selves, what shall we say? Alas! we must own that we are gloomy, heartless sceptics, without so much as a grain of faith, or one single, saving particle of belief. Would that it were otherwise would that we could only so much as imagine that cholera has been, is, or will be cured by the thousand and one plans, of happy memory, already published, publishing, or to be published. Carbonari that we are, we believe not a word of it. No. XXXIV.

In sober sadness, when we look at the official reports, and when we pay regard to our own experience, we cannot attach the slightest importance to the statements of cures in the weekly and other journals. In point of fact, we know no better mode of treating cholera now than when it first appeared in the island, and the really severe cases are just as fatal as they ever have been. The only solid benefit that has hitherto been derived from the investigation of the malady in this country, is the attention directed to the premonitory symptoms, especially the diarrhoea.

We have frequently been asked if our opinions on the question of contagion have been modified by longer experience. We say most unhesitatingly, no. We were contingent contagionists, and contingent contagionists we remain. Under favourable circumstances we have believed and do believe in the propagation of the disease by contagion, but under ordinary circumstances we deny it. Who sees it spread in a family where ventilation is procurable and cleanliness observed-how many have been attacked in the household of Mrs. Smith, of Lord Holland, of the Bishop of London, nay, even of Majesty? But we are not about to rip up this discussion, for we think it acknowledged on all hands, that few but the most bigotted and most blind imagine that cholera is the virulent contagion which many would have us believe it.

The Medical Gazette has lately related two circumstances not undeserving of attention. The first is the appearance of cholera in Canada. It is stated, (we cannot lay our hands on the number,) that the disease appeared soon after the arrival of an emigrant ship from an Irish port where the cholera prevailed, and that in the first instance it attacked the emigrants, and from them spread to the inhabitants of Quebec. Such statements should hardly be received on vague authority, not even on the word of that omnipresent personage," a correspondent on whom we can rely." It will be time to pay attention to such facts when they come in a questionable shape. Our contemporary, indeed, appears to have a fancy for such props on NN