PARISIAN MEDICAL NEWS. PRESCRIPTIONS AND FORMULAS. VITILIGO; MR. CHAUSIT'S PRESCRIPTION.-Vitiligo is the name by which pathologists designate partial and circumscribed discoloration of the skin of the parts usually covered with hair. These spots acquire a milky whiteness, analogous to that of scars, but remain perfectly smooth. Mr. Bazin ascribes the disease to the presence of the microscopic fungus of porrigo favosa; it habitually invades the scalp, and is characterised by the formation of smooth, discoloured, circular bald patches, a diseased condition of the hair, and especially a darker aspect of the skin around the margin of the patches. The contagious character of vitiligo is not a demonstrated fact. The advocates of the parasite theory, Messrs. Bazin and Hardy, advise depilation, not only over the surface of the patches, but along the edges, in order to prevent propagation of the disease. Medull. Bovis, Ziv. ; Ess, limon., j. has subsided; otherwise the symptoms might be exacerbated, and a valuable remedy would unfairly be accused of the aggravation. Ash-leaves may be used both externally and inwardly. Internally Mr. Delarue exhibits an infusion prepared with two drachms and a half of the ash-leaves, for about six ounces of boiling water. The The dose is a teacupful every three hours, or night and morning only, according to the severity of the case. infusion should be sweetened, and aromatised with a few Mr. Pouget prescribes the powdered leaf (eighteen grains for three ounces and a half of boiling water). mint-leaves. In gout a teacupful night and morning is sufficient, but the treatment must be persevered in longer. This remedy taken for a week or ten days every month indefinitely postpones the attacks of gout, and eventually cures the disease. The decoction may also be used for enemas; and the leaves heated in a stove, and applied over the painful parts, form an efficient sedative poultice. AMENORRHOEA. In a letter addressed to Mr. Bouisson, of Montpelier, and published by the Gazette Hebdomadaire, Mr. Courty gives an account of his visit to Scotland, and describes as follows Mr. Simpson's treatment of amenorrhoea : This gentleman inserts into the uterus a hollow sound, fenestrated at one extremity, and connected at the other with a small sucking-pump. When the instrument is worked, the mucous lining of the womb becomes congested, and after a few applications repeated every day at the catemenial period, the discharge is re-established. THE USE OF HOT AIR-BATHS IN ALBUMINOUS NEPHRITIS. -Dr. Delalande, a military surgeon, states in his inaugural thesis that Professor Kuss considers the hot air-bath as an unfailing remedy in the acute stage of albuminous nephritis Every morning lotions with a flannel brush moistened Ten cases in which a complete cure was effected by this with: B Tinct. quinæ. saturat., 5j. After twenty-eight days' treatment, a few thin hairs made their appearance, which gradually gained in strength and became thicker. The skin soon recovered its natural colour, and in the course of eight weeks the hair entirely resumed its healthy aspect. This patient was a woman of thirty-five; Mr. Chausit again saw her after an interval of twelve months: no trace of the bald patch was visible, and it was covered with a crop of hair as vigorous and handsome as the adjacent parts. The second case was that of a clerk in the Financial Administration, aged fifty-two; the disease had broken out on the head and face after severe mental suffering. Five patches were observable on the scalp, and the affection occupied the right side of the chin and upper lip, from which the hair and beard had fallen off. of: Prescription: To take night and morning a tablespoonful B Liq. soda arseniatis (Pearson's solution), Zij. ; Alkaline lotions and baths. The treatment was persevered in for a fortnight, when the hair and beard began again to grow, but of a grey colour. In the course of four months a complete cure was effected, and but for the whiteness of the hair it would have been impossible to discover the spots formerly occupied by the patches. EFFICACY OF ASH-LEAVES IN RHEUMATISM AND GOUT. -The France Médicale devotes to the medicinal properties of ash-leaves, recommended in rheumatism and gout by Messrs. Delarue, Pouget and Barbotin, an article from which we extract the following passages: The effects of these leaves in the above-mentioned affections suggest a valuable distinction: from a careful survey of the cases in which they proved beneficial, it appears that they are appropriate in the sub-acute and chronic forms of disease only. They should not be resorted to before the inflammatory stage method are adduced in favour of its efficacy. The simplest apparatus may be used, and the most common is the lamp-bath in use in all hydropathic establishments, and which can readily be constructed with a cane-bottomed chair, a spirit lamp, and a couple of blankets. LEARNED SOCIETIES. ACADEMY OF SCIENCES.-Mr. Jobert de Lamballe, who, on several previous occasions, has addressed the Academy on the subject of the regeneration of tendons, communicated the result of his further researches on this interesting question. From these inquiries, it appears that the periosteum is not endowed with sensation except in the regions in which nervous filaments penetrate into the bones. Mr. Jobert expresses himself somewhat ambiguously, and would seem to share in the doubts entertained by Haller, who, speaking of the periosteum, says: "It is difficult to decide on the presence or absence of sensation in that membrane." A few days before his death, caused by a wound, accidentally inflicted on himself during an operation, Mr. Reybard, of Lyons, forwarded to the Institute a short paper in which he dwelt on the benefits derivable from a procedure which he calls obstructive catheterism of the urethra. Hitherto, said he, the introduction of an instrument into the bladder has been deemed necessary for the evacuation of the contents of that reservoir. The same result may, how ever, in most cases, be attained by the insertion into the urethra of a bougie terminated by a bulb, whether the instrument be withdrawn immediately after miction, or be left permanently in the duct. This painless operation is easily performed, and is not so hazardous as catheterism of the bladder. At the meeting of August 24th, Mr. Velpeau read a memoir, forwarded by Mr. Tavernier, on a new mode of union of wounds, calculated to prevent unsightly scars. After the excision of a cyst of the neck in a young lady, Mr. Tavernier, desirous of avoiding the formation of the disfiguring cicatrix, which is usually apparent after the removal of a suppurating ganglion, resorted to the following procedure: "I united the lips of the incision, which was more than three inches in length, provisionally with serres-fines; when the space previously occupied by the cyst had filled with blood, all copious outward hæmorrhage having ceased, I closed the wound definitely with collodion, removing the serres-fines one after the other. At the inferior angle of the incision, I left a minute aperture, and consolidated the whole by a fresh layer of the adhesive liquid. Primary union took place, and not a single drop of pus escaped from the orifice which prudential considerations had induced me to leave. After an interval of a week, I removed the collodion; the scar was of a deep red, but perfectly straight; it has since then (four months and a half) contracted, become paler, and promises to become invisible to persons unaware of the operation which has been performed." In the author's opinion, this procedure prevents the scar from falling in, and is an advantageous substitute for adhesive bands, the action of which is not to be trusted, and which being opaque prevent the surgeon from watching the progress of cicatrisation. It replaces ligatures, the application of which is painful, and which may give rise to serious complications; and, in addition, protects from the contact of air wounds in which loss of substance has been inflicted. Mr. de Luca then read a communication relative to organic chemistry. At Pompei a baker's house has been recently uncovered, and in the oven were found 81 loaves, 76 of which weighed from 16 to 18 oz. ; 4 from 20 to 23 oz ; and 1 nearly two pounds and a half. All these loaves are outwardly of a dark brown colour, which is rather lighter in the central parts. The crust is hard and compact, and the crumb brittle and shining, like coal. Chemical analysis shows that the composition of this bread is not exactly the same in all its parts, and that the elements appropriate to nutrition are more abundant in the centre. ACADEMY OF MEDICINE.-After Messrs. Dubois and Parchappe, whose views we reproduced in our last number, Messrs. Béclard, Piorry, Bouley, Bouvier, Reynal, Vernois, and Gosselin, addressed the Academy on the subject of vivisections. "That abuses have crept in in the practice of vivisections," said Mr. Béclard, "is an undeniable fact. But in contending with abuse, we must cautiously avoid interfering with legitimate use, and restricting the liberty of tuition. Let us by all means protect animals, but at the same time let us not profane the temple of science." ming to which ducks and geese are indebted for the diseased liver which our most earnest philozoists unscrupulously relish. Mr. Piorry suggests, in accordance with an idea which the Union Médicale has frequently propounded, that in scientific experiments the enemies of our hen-coops, such as the fox, weasel, rat, et hoc genus omne, be substituted for the dog and horse. Mr. Bouley cannot agree with Mr. Béclard, and regards the performance of experimental operations on living animals indispensable to the attainment of proficiency in Veterinary Surgery; to these practical exercises must be ascribed the superiority of French, over German and English Veterinary Colleges, a superiority attested by the number of foreign students who having already received their diploma at home, consider it necessary to complete their studies in France. "Let it not be supposed," said Mr. Bouley, "that the English, who are so compassionate in their own country, display in our Schools any repugnancy for these preparatory studies. They are, on the contrary, the most zealous of our pupils, and do not show more tenderness to the unfortunate animals than they would to rebellious Sepoys. When these gentlemen return home, far from being censured by the societies instituted for the prevention of cruelty to animals, they are, on the contrary, treated with marked favour, and soon become popular practitioners." The abuses alluded to by Mr. Dubois d'Amiens have, according to Mr. Bouley, been greatly exaggerated; several animal, but they were minor and almost painless procedures, operations may occasionally have been performed on the same unavoidably instituted on one horse on account of the dearth of subjects. "The matter under consideration is not one to which rules and regulations can be applied; the surgeon must be guided by his own conscience. The dignity of science and the independence of the savant would be fatally compromised, were it possible for a police agent to interrupt a lecture in the name of the law, and threaten to report on the professor's proceedings?" • . . Mr. Bouvier, after declaring that experimental physiology should disdain any reply to the censures of its detractors, and hat this branch of tuition is "one of the imperishable glories of French Science," entirely agreed with Mr. Bouley's observations. Persons prejudiced against the study of Mr. Béclard opines, however, that vivisections are not in- operative surgery on the living animal, inquire why veteridispensable for the education of the pupils in Veterinary Col-nary should not, like medical students, be enabled to acquire leges, and that the performance of experimental operations on proficiency by operating on the dead subject? Now, Mr. living horses may be dispensed with. With this exception, Bouvier cannot concede that operations performed on the Mr. Béclard rejects every proposition tending to confine dead are sufficient to impart the necessary steadiness and scientific inquiries by new regulations, and to restrict the free- dexterity to the surgeon's hand. After thousands of dom of the experimentalist. In conclusion, he remarked that operations thus learned, the student has yet another apprenprohibitions would be less likely to attain the desired object, ticeship to go through, before he can pretend to the title of than an appeal to the good feelings of the students. skilful operator. This preliminary knowledge is obviously acquired at the expense of the young practitioner's first patients. It is equally evident that previous performance on animals of those procedures which are nearly the same in the human subject, is the best method of shortening this apprenticeship and diminishing its perils. The most eminent contemporary surgeons, such as Dupuytren, Roux, Béclard, Lisfranc, Blandin, Bérard (to mention only the dead), acquired their well known dexterity by numerous experiments on living animals. Professor Chomel, alluding in 1822 to the method of attaining surgical proficiency, recommends operations on living animals, and Amussat was so deeply impressed with their utility, that he established a course of practical tuition of this kind for students intending to devote themselves to the practice of surgery. "Previously to addressing themselves to the human subject," says Mr. Magendie, "would it not be better for surgeons to operate first on animals? . . I think that, as a complement of a good medical education, experiments on living animals should be required, and that surgeons should not, in future, be obliged to purchase their experience at the expense of their fellow creatures. Applying these principles to tracheotomy, an operation occa According to Professor Piorry, vivisections are indispensable to the acquisition of a knowledge of the diseases which may affect the human subject, and of the remedies appropriate to their cure. They have been at once the origin and the demonstration of the most important discoveries in physiology, in pathology, in forensic medicine, and in therapeutics; that they are not in opposition with humane feelings, is proved by their object, which is the preservation of our species. The experimentalists' own sense of propriety must be trusted to conciliate scientific utility with the imperative requirements of compassionate feelings; experiments instituted for no useful purpose are but a wanton cruelty-the conduct of the physiologist must be governed by the dictates of conscience, not by mere laws and regulations. Mr. Piorry professes but little respect for the affected sentimentality of people who loudly censure vivisections, and yet do not notice the tortures inflicted on certain animals, for the gratification of human gluttony. Surely the sufferings of the eel skinned alive, of the oyster, of the lobster tossed alive into boiling water, are worthy of compassion. Can anything be more barbarous than the cram sionally entrusted, at the Hospital for Infancy, to inexperienced | The professor who performs new experiments on animals cominternes, Mr. Bouvier remarked, that if these pupils, doubtless otherwise highly educated, had previously tried their hand on living animals, they would, when first called upon to operate on children, display a degree of dexterity highly advantageous to their little patients. A few children more might thus annually be saved, and families would be spared the grief caused by the death of these infants. Surely no Society for the Prevention of Cruelty to Animals, not even an English one, could object to this! Therefore, so far from seeking to suppress exercises of operative surgery on living animals in our veterinary schools, powerful motives might be urged for their introduction into the curriculum of medical studies. It is unnecessary to reproduce the observations of Mr. Reynal, who entirely agreed with those which had fallen from Mr. Bouley. Mr. Vernois then addressed the Academy, and more especially alluded in his reply to the remarks of the Press and of some scientific periodicals. "The adversaries of the method of vivisections," said he, "have brought forward arguments based on morality; they have spoken of ferocious and cruel instincts developed by the sight and practice of physiological experiments. This is an undeserved insult offered to the eminent men, who have raised to so high a standard the study of experimental physiology in France. Prejudice and false reasoning are at the bottom of this strange perversion of ideas. Physiologists and vivisectors are represented as mere butchers, and yet it is surely impossible to meet kinder and milder men than Cl. Bernard, Longet, and Ségalas. It is impossible, even in societies instituted for the prevention of cruelty, to meet with individuals who are fonder of animals than those I have named, and surely we, who have been present at their lectures and witnessed their and Mr. Magendie's experiments, are not entirely destitute of human compassion! mits no abuse, but merely illustrates by positive proof the facts adduced in his lecture. The inquirer who repeats old experiments or verifies facts already known, is not guilty of abuse; it is a duty to test the truth of previously acquired knowledge, and to demonstrate it before the pupils in a striking manner. Students who practise vivisections commit no abuse; their objects are general utility and the progress of science, and it is unjustifiable to represent them as actuated by the frivolous and barbarous desire of torturing an animal. If vivisections are prohibited, physiology is at a stand-still. Had they been formerly interdicted, Spallanzani, Charles Bell, Magendie, and Claude Bernard would be unknown. Students of veterinary surgery who perform operations on living animals are not guilty of abuse; the term should, therefore, be struck out from our discussions. "I object to the concluding resolutions of the report because they are tame, superfluous, and unjust. I more especially object to the answer framed by Mr. Dubois d'Amiens to the communication of the Minister, because it is an outrage on the liberty of tuition and an insult to the dignity of science. The academy and the government must trust en tirely to the wisdom and conscientious feelings of the operators." Mr. Gosselin then moved the adoption of the resolutions we have stated (Art. 6531), and which, with the addition of an amendment proposed by Mr. Bouley, relative to the study of veterinary surgery, were unanimously adopted, the original resolutions of the committee having previously fallen to the ground. Che Medical Circular. ORIGINAL COMMUNICATIONS. By GEORGE CORFE, M.D., M.R.C.P.L. Physician to the Western General Dispensary. "Mr. Piorry suggests that domestic animals be spared, and that those which are useless or noxious be preferred for the CASES OF LARYNGITIS AND OF TRACHEOTOMY. purpose of experiment, and the suggestion assuredly arises from a good feeling. But it is unfortunately impracticable. The operator must act in full security, and not be disturbed by the fear of a bite. This could not be with noxious animals, a hyena or jackal for instance. It is evidently better to use hens or rabbits, which would moreover be sacrificed for culinary purposes. "I contend that operations on living animals are useful, necessary, and indispensable; that they should be performed publicly on patient animals accustomed to the presence and society of man. "The matter is not susceptible of administrative regulations; any attempt to enforce such regulations would seriously detract from the dignity of science, and the freedom of its professors. What! when the Emperor has but just founded a prize for experimental physiology, as a signal encouragement to practical studies; when the Minister of Public Instruction has brought down to the present day the tuition of history in our colleges; a protest is entered against physiological experiment, and an effort made to shackle the professors of our universities and to mutilate their lectures. radical. "The Academy cannot meet attacks of this nature by half measures; its conclusions must be precise, absolute, and We should reply to the Minister that the complaints from the other side of the Channel are utterly unfounded; that it would be improper to suggest any restrictive measures; that in the event of the occurrence of abuses, which we have no reason to foresee, the regulations of our universities would be amply sufficient to restore to the various methods of instruction the dignity and morality for which they have hitherto been always conspicuous." The debate was concluded by a speech delivered by Mr. Gosselin, who briefly summarised the various opinions emitted by the preceding orators. He entered his protest against the term abuses, which had recurred several times in the course of the discussion, and implied an undeserved censure on physiologists and vivisectors. "It is important," said Mr. Gosselin, "to establish the fact that in our laboratories and amphitheatres, pain is not unnecessarily inflicted, and the life of animals wantonly sacrificed. In an excellent treatise on Croup recently put forth by M. Roger in 'Les Archives Générales de Médecine,' April 1862, that gentleman asserts that at "L'Hôpital des enfans malades" in Paris, 20 per cent. of the children operated upon by tracheotomy, for the relief of impending suffocation from this disease recovered. M. Bretonneau performed it seventeen times under similar circumstances, and success attended him in five instances. His pupil, M. Trousseau, states that up to the year 1835, 18 out of 60 operations were successful, from Andre's first performance of it in London in 1782. M. Trousseau has himself opened the trachea thirty-six times in this disease, and in nine instances his patients recovered. Velpeau, Bouchut, and Guersant are equally favourable to its adoption, (a). British surgeons, on the other hand, have met with no success, and therefore no encouragement, so as to induce them to resort to it. Whence arises this discrepancy in the favourable results of so important an operation? Having been a witness during the last thirty-five years to a larger number of fatal cases of infantile croup and laryngitis than falls to the lot of the generality of practitioners, and having observed in two dozen cases at least of operation, the fatality of the remedy, it has often struck my mind that we are guilty of great inattention to some important evidences which should demand or forbid tracheotomy in the course of the disease. These evidences are so clear, and founded upon such well established facts in pathology, that they are worth our deepest consideration. M. Trousseau's language is very emphatic, "I formerly said it (tracheotomy) must be performed as late as possible, whereas, now that I have had numerous successful cases, I say it must be performed as soon as possible." For not more than one patient in ten was lost, where the operation was performed while the false membrane was only in the larynx, but scarcely one in tea was saved in operations on those children whose bronchi were already invested with pellicular concretions. Dr. Watson in his forty-fifth lecture draws the same argument in favour of its early performance as M. Trousseau, viz., That, as in hernia, the main success of the operations depend upon their being done at the earliest period. But, we may ask, how are we to assure ourselves of the definite character of the early and of the late stage of croup? In other words, when would Mr. T., the great continental authority, perform it and when (a) Vide 'Memoirs on Diphtheria, Tracheotomy,' &c., &c.. New Sydenham Society, 1859. By R. H. Semple, M.D. would he withold? Let us interrogate ourselves on the following points in connection with the disease. 1. Is there much dysphagia, at least, much sense of suffocation in attempting deglutition? 2. Is there utter loss of vocal modulation? 3. Is the dyspnoea such that no adequate cause for it can be discovered in the thorax, but such as arises from laryngeal distress? 4. Is tenderness felt and anxiety evinced on pressing the Pomum Adami or the Crico Thyroidean space? mena. If the reply to these four questions is in the affirmative, then not an hour should be lost, and tracheotomy must be resorted to, if any relief is anticipated from its adoption. The reasons for so doing are plain enough. If we believe, first, that the epiglottis commands the entrance into the laryngeal ventricles; secondly, that the Recurrent nerve controls its motor muscles; thirdly, that the Afferent (superior laryngeal nerve) spreads its sentient branches over its mucous surface; and fourthly, that the anterior borders of the vocal cords are more concerned in vocalization, whilst the posterior edges are employed in respiration; then indeed, may we be alarmed when we observe such active derangement of these four vital phenoReferring to the first of these derangements, we may be assured that the epiglottis has become stiffened by erysipelatous or acute inflammatory cedema; that the dysphagia is not a mere difficulty in closing the pharyngeal bag, as is the case in glossitis after swallowing a corrosive poison, but that peculiar dread of calling the pharyngeal constrictors into action, lest the gaping, laryngeal cavity, with its semi-erect epiglottis, should also swallow in a particle of food, and thus induce the horrifying sense of instant suffocation. The second distress must be viewed under the following circumstances. We may have the most perfect laryngeal intonation without speech, as in singing without words; so may we utter in whispers distinct articulate sounds without any laryngeal tone: "The tongue, the lips articulate the throat With soft vibration, modulates the note."-Darwin. If then the patient has lost all " timbre" in the voice-(ie., pulsation of columns of pulmonary air upon the vocal cords, as the term implies) and speaks only in an inaudible whisper, the glottis is fast closing upon the vital air around him. With regard to the third question, it is presumed that the practitioner will fully satisfy his mind of the healthy condition of the whole respiratory tract below the cricoid cartilage ere he considers the operation eligible. The fourth phenomenon is more corrobative of impending danger than we are aware of. If the patient refers all the distress to the larynx, and pressure on its body aggravates that distress, it is certain that the glottis is narrowed to the utmost limit that is compatible with a few hours more of life. Now, although the vocal cords may be closely approximated, as in singing a high treble note, yet the posterior margins of the "rima-glottidis " remain nearly as open as they are when the cords are wide apart; or again, the voice may be lost, as in ordinary catarrh, yet no impediment exist in the respiration; if therefore, pressure over the vocal cords in croupal aphonia induces a sense of suffocation, it may be inferred that the respiratory portion of the glottidean borders will soon fail in their office also. When such havoc has been thus rapidly made at that "Door of Life," the rimaglottidis, the recurrent will often slam to that vital entrance with a suddenness and invincibility which no convulsive efforts can stay or spasmodic struggles overcome, and instant death follows. Yet even then the operation may be attempted and happily prove successful, as I witnessed in all the cases of resuscitation by its timely adoption, recorded by Dr. Watson in his forty-fifth lecture. (a) I lately saw a painful instance of this deathly spasm in a lady on whom I was in attendance in consultation with Robert Harper, Esq., of Westbourne Grove. The fatal attack was ushered in with acute diphtheritic laryngitis, and shortly involved the pharynx and surrounding tissues. We had resolved on opening the trachea if our remedial measures did not afford relief in a few hours after our morning visit, but on repairing to the house in the afternoon, we found that sudden spasm had come on an hour before, and death was instantaneous. pre If the inflammatory damage has extended below the laryngeal cavity, and crept down to the 1st and 2nd tracheal rings, the operation, as a rule, will be of no avail. It is essential to its success that the knife, or trocar and canula, should pierce a portion of the mucous surface, not yet involved in the super-imposed inflamed membrane; for as the wounding of such a membrane, and the sence of a foreign body, like a canula, will heighten that inflammation, so, on the other hand, if the opening be made on a healthy structure, and the air be admitted over a normal surface, the probability is much greater that the inflammatory action will be arrested; especially so, if another desideratum be gained-namely, that we are enabled to give perfect quietude to the larynx, so that respiration, in lieu of being carried on, partly by the mouth and partly by the tube (as in the case of extensive croupy deposition (u) Vol. I, page 838. below the cricoid cartilage), is now wholly performed through the tracheal orifice. It is a matter of surprise to many who have witnessed this operation that some eminent surgeons should still insist upon laying open the trachea, from half to one inch in length, with the bistoury, and then attempt to insert the canula. Bretonneau and Trousseau direct that as soon as the incision is made in the trachea, the dilator should be introduced, yet the latter observes that "this proceeding requires considerable practice, for it has often happened to him, that he has placed the blades between the muscles, blood has been sucked down into the bronchial tubes, and the dyspnoea has increased, whilst the hæmorrhage so far from stopping, has come on with more violence." Mr. T.'s object in using the dilator ten or twenty minutes before introducing the canula is to afford opportunity to cleanse and cauterise the mucous membrane. So far it is justifiable, but if no such preparation is determined on, this mode of opening the trachea is highly dangerous; for too often it only increases the distress; the heaving, rolling. and deeply drawn-in position of the trachea, during the operation causes the operator to miss his opening, and before he can hit upon it with the point of the canula, the air-passages have become charged with a suffocative quantity of blood, drawn in from the external wound. Again, if the scalpel opening in the trachea is not hit upon instantly after it is made, the surgeon may plunge its point into a cul-de-sac always formed between the lower portion of the trachea and the soft parts, and this, by its pressure, greatly aggravates the hal -suffocated condition of his patient. I have witnessed this evil in several instances. M. Trousseau gives us a serious warning on this important point; three of his cases were killed by the error, even though the canula had made its entry into the trachea. It is true M. Trousseau insists upon a long canula to obviate this misfortune; but the tube should exactly fit the tracheal opening, and this is an impossibility, for a circular body cannot fit tightly into a longitudinal opening, but should have a corresponding trocar to cut its own exact shape in the trachea, ere we can ensure perfect immobility of the canula. The safest plan is to expose the tracheal rings with a dilator, and then plunge a full sized trocar, with its canula, through the 1st or 2nd ring, adhering to Bretonneau's precept "that the diameter of the canula should always equal the normal diameter of the glottis of the patient." So deeply convinced am I of the great importance of these directions, that it would appear an act of the greatest indiscretion, almost of criminality, if the surgeon should make a scalpel wound of half to one inch in length in the trachea, in order to insert a circular canula therein; whilst the patient is drawing in fatal draughts of arterial and venous blood from the deep external wound. One fatal case at the Hotel-Dieu is given by M. Trousseau in the 'Union Médicale' under the circumstances described, and analogous to the one related below. The reference lately made to the invaluable lectures of the President of the College of Physicians affords me an opportunity of relief of croupal inflammation they should be kept apart from those suggesting that in the enumeration of cases of tracheotomy for the of laryngotomy requiring the operation in laryngitis, so that we may draw some statistical facts in favour of these operations under both diseases. On this account, I have selected the following larynx or its opening, in which twenty-five were operated as fatal cases from thirty instances of acute and chronic disease of the symptoms arose. Of this Number, 12 recovered fully, 3 partially, viz. from two to ten weeks; and 1 was doubtful. 16 9 fatal 25 (To be continued.) ON INFLAMMATION AND RELAXATION OF THE PELVIC ARTICULATIONS. By Dr. G. DE GORREQUER GRIFFITH. House Surgeon "London Surgical Home." These conditions are sometimes found to obtain in the latter months of gestation, but most frequently it is at the parturient period that they manifest themselves. They are not, however confined either to gestation or parturiency, existing, though rarely, under certain other conditions, wholly foreign to, and independent of pregnancy. We shall briefly consider them in the order in which they are above written, inasmuch as the former in its acute or subacute forms is the precursor, if not also the producer, of the latter, rather than the converse; though no doubt the relaxation will at times precede, and perhaps, predispose to the inflammation. The onset of the inflammation may be so insidious as to afford no opportunity for fixing upon any real cause for the discovery of the origo mali, or may be so sudden as by its very suddenness to Nov. 18, 1863.] baffle us in our efforts to decide upon a cause that may be con sidered truly assignable. Symptoms.-Concomitant with the general disturbance indicative of inflammatory action, there are certain local signs which at once point to the rest of the lesion, and are, as regards the intensity of degree, in direct proportion with the extent or amount of the abnormal processes; while the constitutional sympathy also varies with the local changes, being dependent upon them for its excitation. There are uneasiness in the joint or joints involved, pain of a fixed and constant character, varying, however, from a dull aching, heavy, to a severe, cutting, gnawing sensation, or as patients will sometimes tell us, as though a saw was being passed between the bones;" these are greatly aggravated by any disturbing force applied directly or indirectly to the joint, as in moving the trunk or limbs, or even by the individual action of the abdominal muscles, whereby the inflamed parts are made to rub together, or the affected ligaments put upon the stretch. There will be sometimes great irritability of the bladder, a circumstance which I have noticed specially in those cases where the pubic was the unsound articulation, and this irritability will demonstrate itself in various manners, at one time so implicating the entire of the urinary viscus as to occasion retention of urine from want of detrusor power, and subsequently stillicidium, when the viscus becoming overfilled, there can be no longer any retentive action exercised by the cervicourethral muscular fibres; at another, involving only these latter fibres, and creating such an augmented sphincteric force as to allow little, if any, fluid to be expelled by the detrusor urinæ. The character of the urine may itself deviate from its natural standard, and may be permanently restored only by the removal of the exciting agent. There may or may not be present actual leucorrhoea, but very frequently we shall find the vaginal secretion exceed its normal 66 a sensation as though the womb were quantity, and attended by slipping through the passage." The rectum, more particularly in those instances where the sacro-iliac or sacral joints are the subjects of the lesion, sharing in the disturbance, will be affected with tenesmus and "a constant uncomfortableness," or an irritation to which we would almost apply the term pruritus. Vaginal examination will evince great tenderness at the back of the pubis, should the disease be situated in that articulation; while by vaginal, rectal, and external manipulation, the sacro-iliac joints will be in the same manner found incapable of pressure, should they be affected. The mode I prefer for conducting the vaginal exploration is by passing into the canal the thumb, while the forefinger of the same hand (the right, with which we usually examine patients, they lying in the ordinary obstetric position), is employed externally to compress the front of the joint. By the adoption of this method we are enabled to detect the presence of pus very accurately, as When also with the same degree of nicety the exact seat of pain. the inflammatory is about to pass into the suppurative stage, it does so somewhat rapidly, and soon the joint will be filled with the products of this latter; nor will the presence of pus be the only pathological change, since the bones will be affected, their cartilages eroded at particular points, or completely (after some little time) removed, they themselves found to be carious, and issuing from all this seat of mischief, a fetid, acrid, unhealthy discharge, through a wound in its appearance as unhealthy. The entire joint may be the seat of pulpy degeneration. The unhealthy character of this affection is readily explained, when we bear in mind the unhealthiness of the patient's general habit, which in these cases is most frequently the strumous, a diathesis in itself difficult of treatment. Suppuration will behave itself here, as when occurring in any other part of the body where dense, unyielding, tendinous structures keep its products pent up, and may induce by the severity of constitutional disturbance most untoward, even fatal results, before there is any tendency to external discharge. Two such cases are put on record by Messrs. Hiller and Monod. anchylosis. Relaxation of the different pelvic articulations may be the "It is now," says Cazenave, “generally admitted that a softening of the symphyses really occurs in most women during gestation,' and this may be to such a degree as to admit of divarication of the pubes for an inch or more, as is mentioned by Hunter and Morgagni. Symptoms:-Uneasiness, and a sensation of yielding of the articulation or articulations affected; a consciousness of looseness on the part of the patient at the seat of disease, and "as though the entire trunk would slip between the thighs," which seem, and actually are, incapable of affording support to the body; inability to walk without support, and sometimes even when support is rendered; difficulty in rising from the sitting to the erect posture, or of resuming the former with ease, the patient falling down in the seat suddenly; difficulty also in standing, which, however, may be fully obviated by compression being exercised upon the pelvis by the hands of another, or by the tight swathing with a bandage or binder; pain on exercise of the gentlest kind, often indeed when the person is perfectly quiescent, and which may extend up along the back or down the thighs; mobility of the bones and a crackling of the mobile joints evident to the patient, as well as to the attendant, and exaggerated by manual examination: these may have set in after, or preceded labour. The return to the normal condition may be speedy or protracted, the period of recovery extending itself over days, weeks, months, or years, before it is complete. softened by imbibition of fluids and expanding, effecting the sepaThe causes assigned are:-First, the cartilages are said to become rootlets of ivy in the crevices of a wall, which, as they enlarge, ration of the bones, just as would pieces of sponge, or like the make wider the fissure, or, as Louis institutes the comparison, like porous wooden wedges in the clefts of a rock, which, swelling from the absorption of moisture burst asunder the rock; secondly, mere this latter condition there may be no separation, but a capability relaxation of the ligaments dependent on serous infiltration. With for it, the normal tensive tone of the ligaments being impaired. Thirdly, in conjunction with the latter, there being an excess of Effects in labour. Retardation. First, because the abdominal synovia, under which circumstances an actual separation will occur. muscles are deprived of the "point d'appui," afforded by the pelvis, where it is immovable; secondly, owing to the excessiveness of pain, as the head descends into the pelvis, the woman herself strives to check the labour by restraining the efforts necessary for its advance. By Treatment:-This will be best fulfilled by general and local tonics wherewith may be braced not the constitution only, but likewise the parts immediately involved in the relaxation. local tonics we mean cold vaginal injections, the use of cold water bathing, the cold douche, blisters, and stimulating embrocations. Binding together the entire pelvis by means of a firm, unyielding, bandage is of immense service, and if applied and continued in constant use for some time, proves a valuable adjunct in our treatment. Friction, having for its object the excitation of a certain amount of inflammation, by which may be induced ossific deposit and anchylosis. Nature, however, more frequently sets up the absorptive process, whereby she effects the removal of the retaining ligaments, and procures vent for the matter either posteriorly into the vagina, or anteriorly on the " mons veneris," the groin, or about Scarpa's angle. The treatment to be pursued is the same as we should adopt in any case where phlogistic action happened to be the lesion, always, however, bearing in mind the condition of our puerperal patients (who are generally the sufferers), whether it be We should obtain an exit for the the plethoric or adynamic. matter as soon as its presence is ascertained, and it is found to occasion general irritation; while the aperture of exit is to be made where "pointing" occurs, rather than any particular spot which we might wish to select. The fever attendant upon the suppurative process is of a type distinctly remittent. In the sub-acute, chronic, or even the acute forms of inflammation, I know of no local remedy fraught with so much advantage as the application of a sufficiency of leeches, and the maintaining through their bites, a steady constant issuing of blood into a hot fomentation cloth or poultice till inflammation has been subdued or has at least subsided. When the patient is being exhausted from the disease, we might, I apprehend,turition. Blundell proposes for those cases in which the patient becomes completely invalided, division of the symphysis pubis (if it be the offending joint), and immediately after the operation the binding together of the parts in tight apposition. These remarks I have been induced to make by my having had recently under notice a patient in whom, subsequent to inflammation of the pelvic articulations, relaxation of the same occurred, and continued, with little amendment, for some time after par |