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must carefully distinguish the morbid appearances in such as have died in the early stage, from those which we observe after the secondary disease, under any of its different modifications, has commenced.

Many of Dr. Ochel's colleagues observed that the best preservative against an attack of the epidemic was a powerful emetic. As the disease began to subside in Russia, it was noticed that numerous cases of bilious vomitings and purgings occurred.

Many who had been cured of cholera by the sedative and astringent treatment, recovered exceedingly slowly, and for several weeks after they had been pronounced well, suffered from vertigo, spasms, &c. &c.; but these symptoms quickly disappeared, when the discharge of bile was promoted.-Revue Médicale.

XXIV.

RHINOPLASTIC OPERATION.

THE patient had been long affected with an enormous cancer of the nose, which had resisted every treatment. M. Blandin, having completely excised the diseased part, detached from the forehead a flap of integument, and shaped it to the stump of the nose; but he did not divide the pedicle of the flap as has been usually done; instead of doing this, he separated the skin from it, and then cut away the integuments from the root of the nose; the opposite raw surfaces were brought together, and quickly united. By this manoeuvre, the new nose continued to retain its communication with the blood-vessels and nerves, which imparted life to it at first, and was thereby much stronger and less likely to be affected by cold and other accidents.-Journal Hebdomad.

XXV.

CURIOUS CASE, IN WHICH THE REAL SEX OF A CHILD WAS NOT DISCOVERED TILL he WAS 18 YEARS OLD.

E. D—c. was born on the 13th August, 1812, and appeared to be a female, was registered as such, and educated as a girl till 1831. In June of this year she consulted M. Gendrin on account of ophthalmia in both eyes. He was struck with the beard on her face, the bass tone of her voice, and the developement of the pomum Adami. The catamenia had not appeared. Subsequently she mentioned that there was an irregularity in the genital organs, and that the irregularity had been increasing ever since the age of puberty, which with her commenced about six years before, as indicated by the change of voice, and the black, stiff hair which appeared in different parts of the body. The mother stated that her child, when young, had the activity, and had always preferred the sports of boys, to the quieter amusements of girls.

She has not yet shewn any attachment for either sex. On examining the genital organs, a longitunal fissure, like a valve, extended from the inferior edge of the symphisis pubis to near the auus. Rather higher up than the usual situation of the clitoris, was observed a loose cylindrical organ, 15 lines long and about five or six thick, covered by a very fine and extensible membrane, and ending in a regularly formed glans, having a corona round its base. The vena dorsalis penis was seen on its upper surface. A prepuce covered one half of its surface; the skin, of which this prepuce was formed, was continuous with the margins of the vulvalike fissure in the perineum. Along the under surface of this organ was a deep channel, or groove, which terminated posteriorly in the vulva, and at this point of junction were observed 5 open, irregularly arranged orifices, not unlike those of the vasa efferentia round the verumontanum. A smooth mucous membrane covered the surface of this gutter, which was in lieu of a urethra, and it presented faint traces of the

longitudinal furrows observed in the natural passage. With much difficulty the finger could be introduced, to the depth of three inches, into the vulva, but no opening was detected in it. A straight instrument might be passed in the direction, from the symphisis pubis to the middle of the sacrum, for three inches and a half; and when the finger was carried up the rectum, the instrument might be felt, and it was ascertained that there was not more than two or three lines thickness of substance interposed. Two elastic roundish bodies were felt by the finger round the supposed neck of the bladder; these were probably the lobes of the prostate. No meatus urinarius could be perceived; but, as the water was discharged downwards, the orifice must have been situated in the perineal canal. At first, this canal was considered to be merely a dilated urethra, but the circumstance of the straight instrument being stopped at the depth of three inches and a half, and not appearing to be embraced by a tight canal, contradicted this idea. By perseverance, however, a curved instrument directed upwards, was passed into the bladder, and the finger in the rectum did not discover any intervening substance, but the mere walls of the gut and bladder-a thickness of four lines at the most. There was no trace of scrotum, testicle, or of spermatic cord. The mammæ were not at all developed. The young person declared that the cylindrical organ, or imperfect penis, was sometimes enlarged and erected, and the erections had occasionally been followed by a discharge of a whitish, thick, viscid fluid. The rami of the pubes and the tubera ischii were more approximated than usual; the hips projecting; the buttocks flattened, and the thighs not rounded, and verging inwards as in females. The mons veneris, the linea alba, the chest, chin and cheeks, and the extremities were covered with hair, and the general configuration of the body was decidedly masculine.

The medical men, after a most careful examination, concluded that the sex of the person had been mistaken, and the civil tribunal, therefore, ordered that the registry

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PROBABLE CAUSE OF EXTRA-UTERINE
PREGNANCY.

MADAME E. on the 26th Feb. 1817, was suddenly much terrified, while receiving the embraces of her husband, by the fall of a stone which had been thrown against the window of her bed-room. She had no family hitherto, though she had been married for 12 years.

The catamenia had regularly appeared till after this date, when the other symptoms of pregnancy presented themselves. On the 13th April, she had a violent attack of bearing down, and of excruciating pain in the left side of the hypogastrium, which very closely simulated the threatening of an abortion. The symptoms gradually passed by, but again returned in two months. On the 6th Dec. all the signs of child-birth came on; but the physician could not, by examining, reach the os uteri with his finger. After a few hours of suffering, all pains left her, and from this moment the motions of the child, which

had hitherto been very obvious, altogether ceased. For three months after this date, she had repeated attacks of inflammation in the abdomen, and was reduced to a state of marasmus, when, very unexpectedly, the catamenia reappeared and health was quickly re-established. The belly, however, remained very large. After two years of widowhood she again married, and enjoyed good health till April, 1824, when she died from an attack of peritonitis, followed by diarrhoea. On opening the abdomen, the foetor was insupportable, and M. Beclard, therefore, contented himself by removing the tumour along with the uterus, to which it adhered. The foetus was of the female sex and of the full size; it was enclosed in a bag, situated to the left of the womb, and was in a great measure converted into a fatty matter, like adipocire.-Archives Générales.

XXVIII.

TORSION OF THE ARTERIES AFTER
SURGICAL OPERATIONS.

Case 1. A young man's leg was amputated by the circular incision. The anterior and posterior tibial, and the peroneal arteries, were twisted in the simple manner recommended by M. Amussat, without any previous laceration of the internal and middle tunics. The time occupied was much shorter than required for applying three ligatures; one of the tibial veins, which was bleeding profusely, was likewise twisted. There was an oozing, more serous than bloody, from the wound for several days. The wound did not heal favourably, as the patient's health was not good; in six weeks, however, the stump was quite cicatrized.

Case 2. A woman, aged 48, had her thigh amputated; the femoral artery, well detached from the accompanying nerve, was twisted-only one other vessel required torsion. On the fourth day the bandages were removed; they were dry and very little stained the wound was quite healed in four weeks.

This patient having subsequently died of phthisis, an opportunity was afforded of examining the vessels; the femoral artery was closed exteriorly by condensed cellular membrane, and plugged inwardly by a fibrinous white clot. Its walls and calibre were quite normal.

Case 3. A man, aged 52, was admitted into the hospital with an enormous diffused, aneurismatic swelling of the lower third of the thigh: amputation was performed at the upper third. The femoral artery was attempted to be twisted, but it gave way at the third turn of the hand, leaving a gaping orifice; a ligature was, therefore, appliedthe muscular branches were, however, secured by torsion. For several days after the operation, there was an inconsiderable serous oozing from the wound, which, however, was completely cicatrized in about six weeks.

Case 4. A man, aged 64, had cancer of the penis, which required removal by the knife; five arteries were twisted. It was found much more difficult to detach these vessels from their connexions than in the previous operations. The wound healed within a month.

In addition to the above cases, several others are alluded to of amputations, in which complete union of the wound took place in 6, 8, 12, 15, and 18 days.-Journ. Hebdom.

XXIX.

LETTER ON CHOLERA, BY PROFESSOR
DELPECH.

AN attentive examination of the bodies of those who have died of cholera, clearly demonstrates that its essential or proximate cause is an active and disorganising inflammation of the solar plexus, semilunar, ganglia, and renal plexuses, which constitute the great central point of the ganglionic system; and this inflamination is sometimes propagated to the pneumo-gastric nerves, to the pneumo-cardiac plexus, and even to the medulla oblongata. Numerous other patholog

ical appearances have been remarked; but none of these are uniform; and many are evidently the result of pernicious treatment. The chain of symptoms most beautifully corroborates this hypothesis; for all the organs which are most involved, are under the influence and control of ganglionic nerves; namely, the liver, the circulating and respiratory apparatuses, the abdominal viscera, including the kidneys and bladder. A curious fact is, that the vomitings and purgings consist of the serum of the blood, which being thus deprived of its watery portion, becomes thicker and thicker;—now this change cannot be conceived to take place without an important lesion of the trisplanchnic nerve. The nature of this lesion we have explained to be an inflammation, and we should therefore infer that an anthiphlogistic treatment must be most successful; practice has confirmed the truth of the conjecture: bleeding is the sheet-anchor of safety, when the severe symptoms have set in; the earlier stages may be combated with opium, warm baths, and strict abstinence. When collapse has taken place, we must employ stimulants, by giving them both inwardly and by rubbing them on the skin, or, what is much better, by injecting a diffusible one, such as camphor, into a vein, with the view of rousing the circulation, to enable us to draw more blood. Journ. Hebdom.

XXX.

observed very distinctly to be drawn together. Wishing to shew that the distortion of the fingers was not at all dependent on any lesion of the tendons, Dupuytren divided them across, one by one; but yet the fingers could not be straightened: a direction was now carefully introduced beneath the palmar fascia, and this divided; and immediately the fingers could be bent back to their natural position.―Journ. Hebdom.

XXXI.

DISEASE OF THE HEART.

A MAN, aged 70, was admitted in the Hôpital de la Pitié, with the following symptoms-great emaciation, somewhat masked by a universal puffiness of the skin; complexion of a purplish hue; ædema of the ancles; dyspnoea; mucous râle; expectoration mucous and copious. Chest sounds well on percussion, except at the posterior and superior half on the left side, and at the præcordial region;—in these parts no respiratory noise to be heard; contractions of the heart feeble; a bruit de soufflet heard, extending to nearly the right clavicle. The pulse is rather small, 90 in the minute, and is slightly intermittent. The bellows sound is not perceptible in the arterial trunk, and is much more distinct in the points corresponding to the left, than to the right cavities of the heart. For five months the sleep has been much disturbed; the patient frequently

PERMANENT CONTRACTION OF THE FIN- awaking from frightful dreams-considera

GERS, CURED BY DIVIDING THE PALMAR APONEUROSIS.

DUPUYTREN has now performed this operation with complete success in upwards of twelve cases; and very lately he had a most satisfactory opportunity of confirming his opinion of the cause of this malady by dissection. An old woman died in the hospital; and it was found that three of the fingers were contracted. The skin of the hand and of the fore-arm having been very carefully dissected off, the aponeurosis was

ble orthopnoea.

Diagnosis. Hypertrophy of the heart, with contraction of the aortic and left auriculoventricular orifices, produced by induration of the valves.

Bleeding, laxatives, and digitalis were ordered. For a fortnight he experienced considerable relief; but soon after died, having been suddenly seized with a severe convulsive cough and bloody expectoration.

Autopsy. A large quantity of water was found in the cavity of the chest ;-inferior lobe of the right lung completely hepatized;

when cut into a sanious matter flowed out. The left lung is partly atrophied, being compressed by the heart, which lies transversely, and occupies a great part of the left side of the thorax. The pericardium contains a bloody serum; its inner surface is villous and unequal; where it is reflected over the heart, it is mamilated, red, and presents several small depositions of coagulated blood, and of false membrane, which form a thin easily separable coating, or layer.

The left ventricle, towards its base, is nearly an inch thick; columnæ carnea much enlarged; its cavity of the size of a goose's egg; aortic orifice is contracted by cartilaginous incrustations; and the contraction is more obvious, in consequence of the increased capacity of the ventricle. The right ventricle is equally hypertrophied, and its walls are at least five lines in thickness, towards the base. Both auricles are dilated proportionally to the augmented size of the ventricles. All the cavities of the heart are filled with blood, partly liquid, partly in clots. The auriculo-ventricular orifices, and likewise the orifice of the pulmonary artery, are quite pervious and free;-only a few trifling incrustations are to be observed on their valves, and also on different points of the aorta. The weight of the heart, when all the large vessels are detached from it, is nearly one pound and three quarters, (800 grammes); its size is double that of a man's fist.

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of the heart; since there is reason to suppose that this latter affection commenced during the patient's youth. In other cases we know that pericarditis will ultimately induce enlargements of the heart, just in the same way that chronic cystitis and gastritis will in course of time cause the muscular coats of the bladder and stomach to be amazingly thickened.-Journ. Hebdom.

XXXII.

CAUTION TO THE PUBLIC, OR HINTS ON SCARLET FEVER.

THE author of this brochure appears to be gifted with qualities somewhat akin to those of the late Lord Castlereagh, of whom it was said, that his chief merit consisted in maintaining an immoveable equanimity of temper, and in being able to discourse on any topic for an hour or two at a time, and when he had finished, none of his hearers could say what he had been speaking about. So it is with our unknown Durham friend; he has been anxious to make a book, and in this he has succeeded, for we have got no fewer than upwards of 150 pages of wellprinted letter-press. Why, then, should he have concealed his name? and why should he voluntarily deprive himself of the "summi honores" of authorship-of seeing his name in print?

The sum and substance of the book is, that scarlet fever is infectious (who doubted it?)-that its virus is peculiar (who thought it otherwise?)—and absolute (pray explain what is the meaning of an absolute virus?)

and that it is specifically infectious in its mildest, as well as in its most malignant form; an assertion which will not be contradicted. The author does not deem it worth his while to establish the truth of the above positions by any facts or observations drawn from experience; bnt vehemently commands conviction, by very copious snatches from multitudinous books. The readers, who, by the bye, are assumed to be chiefly the non-professional public, are refer

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