tainly a natural one, Dr. Chiarenti, an Italian physician, himself a victim to this disease, had recourse to the insufflation of atmospheric air, by means of a common pair of bellows, in his own person. He introduced the pipe of the instrument into his mouth, and, closing the nostrils, he pushed the air forcibly into his lungs, and with instant relief. He continued the operation for a considerable time, and still with the same good effects. By this remedy, he put a speedy period to the paroxysm. He then extended the trial to others, under similar circumstances, and with similar benefit. After a mass of experience with this remedy, he comes to the conclusion, that the artificial insufflation of atmospheric air is not only a means of putting a speedy termination to the paroxysm of asthma, but of radically curing the disease, if organic alterations have not taken place in the lungs.-Journal de Progress. 33. INGESTION OF HOT WATER IN GOUT. In a former Number of this Journal, we alluded to a strange practice introduced by M. Cadet de Vaux, namely, the swallowing immense quantities of hot water for the cure of gout and rheumatism. Dr. Kruger has recently stated a case where this plan was tried by a patient, and the following were the effects. M. Scholz, aged 47 years, began to have gout in May, 1821, which continued to recur, in slight paroxysms, till March, 1826, when they were rather severe. He now read M. Cadet's work on hot water, and determined to test the remedy. On the 20th March, he began with a tumbler of water, as hot as he could drink it, every 15 minutes. The first few glasses threw him into a perspiration, which continued till he took the 30th dose, when nausea and vomiting supervened. He persevered with the hot water, till he comple ted the 38th glass, (each contained about seven ounces,) when his head began to turn, and he was unable to take any more. Epileptiform convulsions succeeded-and all the superficial veins of the body were remarkably distended-respiration stertorous-pulse unaffected-perspiration copious. Some æther was first given, and then 20 grains of ipecacuan, which did not vomit; neither could the bowels be moved by lavements. The patient had no power over the sphincter ani, or the bladder. Diffusible stimuli were next given. Vomiting took place four hours after the exhibition of the ipecacuan, and was succeeded by a paroxysm of convulsions, that left the patient in a state of great exhaustion, and complete privation of intellectual powers. Another convulsive paroxysm was followed by a few hours sleep, from which he awoke with renewal of intellectual functions, but without any recollection of what had passed during the indisposition. The gout, which had been seated in the great toe, at the commencement of the imbibition of warm water, had now disappeared, and did not return for that time. The patient, however, experienced great debility for a considerable time afterwards, requiring a long course of tonics. Another case is related by Dr. Kruger -that of an apothecary, who, having had some distressing dyspeptic symptoms, became affected with gout. In a paroxysm of this last disease, in which the whole body was affected; with heat in the stomach, palpitation of the heart, constipation, and jaundice, the patient had recourse to the Sangrado practice, being tired and disgusted with medicine. He swallowed 40 glasses of hot water, each containing 7 ounces. The consequence was, an immense distension of the body -congestion about the head, delirium, vomitings, copious perspirations, and urinary discharges, &c. by which his strength was greatly exhausted, and his life put in imminent danger. The gout, in this case, did not subside from the feet, and it was a long time before he was able to walk. These effects of copious ingurgitation of hot watery fluids, are curious and interesting to the physiologist and pathologist. It is evident, that a considerable portion, at all events, of the water, must have passed through the circulation, and the effects on the brain were nearly similar in both cases. In the latter case, the abundant perspiration and urinary secretion may have prevented the paroxysms of convulsions, which were so conspicuous in the first patient.-Bibliotheque Med. " November 1. Pu dy; tongue furred, heat of skin moderate during the night, and says himself he had arm is less swelled; brane is evidently state extends beyo the incision on th which was therefor extent of eleven in tinue the saline m calomel, and four cynth, and the inf to be given afterw a due effect is pro "From this ti vered the incisio too late to preve able quantity of skin. "When a d inflammation tal cia of a limb, th it becomes firm, colour; and is erysipelatous b! pidly destroys patient sinks ur when he fancie appearance of t much resemble It is a fatal terr common in pers ed with erysi inflammation or neighbourhood Gunshot Wound Messrs. Mouli published a pap trative of the nat dangerous specie. they condemn th as unnecessary a great numbers of ì part, with the vari antiphlogistic plan. ment recommended Travers, and several in opposition to Hi Lawrence, and some ot however, by a case rela that the celebrated Boy the practice of incisions. we shall give a few particu Case. Mr. R. aged 52 year constitution, was bled in the a 36. CASE OF EMPHYSEMA OF THE SUB- complete freedom from all dyspnea. It was very curious to observe that the interval (for more than a month prior to death) was almost invariably twice as long as the paroxysm. Thus, if the dyspnoea lasted five minutes, the patient had a complete immunity for ten minutes afterwards. The accessions were, like the cessations, instantaneous. He would be conversing quietly with his wife, his children, or his medical attendants, and in the very midst of a sentence, or even of a word, he would be seized with such a panting for breath, that a stranger would suppose he was in articulo-mortis. Equally sudden and abrupt would be the termination of this terrible conflict; and then he would take up the sentence or the word where it had been interrupted by the paroxysm. Towards the close of the scene-that is, for the last three weeks of the patient's life, there were evident symptoms of effusion in the chest, as well as oedema of the lower extremities. Then the respiration could not be heard below the middle of the thorax, in the perpendicular position, though it was quite audible all round the superior parts of the chest. He suddenly expired while conversing with his daughter, in one of the intervals of dyspnoea, on the 23d of October, as he was sitting in his arm chair. The body was examined on the 24th, by Mr. Morrah, Dr. Johnson, and Mr. Stevenson, of the Edgeware Road. There was very considerable effusion, amounting to several pints, in the two sides of the chest. The heart was nearly three times its natural size-all its cavities being greatly dilated, but its parietes not being increased in proportion. The auricles were nearly of their natural thickness, though their cavities were considerably augmented. The right ventricle was passively enlarged. Its parietes were thinner than natural, though its cavity was more than double its proper size. The cavity of the left ventricle was also more than double its usual dimensions, but the parietes presented certain remarkable appearances. In some places, they were full an inch in thickness-in others, not a quarter of an inch. Near the apex of the left ventricle, the muscular structure was white, and condensed every into a substance almost as firm as ligaSa- ment. Between this and the basis of the of ventricle, there were some portions of 34. INFLAMMATION OF THE NECK OF THE BLADDER, WITH STRICTURES ON THE USE OF THE BOUGIE. [Hospice de Perfectionnement.] We introduce the following case, with the view of putting young (and, we are sorry to say, some old) surgeons on their guard against the inconsiderate use of bougies, where there is great sensibility in the urethra and neck of the bladder. 1 Case. A man, about 50 years of age, was brought into the above-mentioned hospital, in Paris, who had had several attacks of gonorrhoea. A catheter was introduced, by way of exploration, to see what could be found, and this introduction produced most exquisite pain, as soon as Remarks. We think it will hardly be denied, that this unfortunate patient met with an untimely end by the imprudent interference of the surgical measures that were pursued. Had this man been treated by leeches to the perineum and anusbarley water-and gentle aperients, with hyosciamus, instead of bougies and balsam copaiba, we have no doubt that he would have been living and well at the present time! We have frequent opportunities of witnessing the injurious effects of bougies in irritable states of the urethra and neck of the bladder; but the foregoing case happening abroad, is introduced as a hint to some of our chirurgicals at home. TEBRÆ. the instrument reached the neck of the 35. LUXATION OF THE CERVICAL VERbladder, with constant and painful micturition afterwards, the urine being highly charged with tough mucus. The patient evinced some febrile symptoms, and disorder of the digestive organs. Dr. Cloquet now wished to throw into the bladder emollient injections, by means of a hollow sound; but was obliged to relinquish this measure, on account of the exquisite sensibility (vive sensibilité) of the neck of the bladder. Diluents were then employed, with low diet, for eight days, at the end of which time, there being no amelioration of the symptoms, balsam of copaiba was exhibited in pretty large doses. Fever, with great irritation of the digestive organs, forced Dr. C. to abandon this medicine. But it was too late; for the fever assumed a low type, and the patient died on the twentieth day after his entrance into the hospital!! Dissection. The contents of the head and thorax were healthy. There were some spots of redness, and other signs of irritation in the mucous membrane of the intestinal canal. The urethra was in its normal state, as far as the membranous portion, but here the most unequivocal signs of inflammation, with thickening of the lining membrane, commenced, and were continued to some distance within the bladder, where the inflammation and thickening gradually disappeared. The prostrate gland was enlarged, and contained a quantity of pus, which was infiltrated into its parenchymatous structure, not collected into a focus.Archives Generales. [M. PINAULT. Hôpital Cochin.] James Bove, aged 31 years, fell on his head from a height of 20 feet, and was carried in a state of insensibility to the above-mentioned hospital, where he soon recovered his senses, and answered correctly to questions. All parts of the body below the arm-pits were completely paralytic. In the upper extremities, also, the sensibility and muscular power were considerably diminished. On examining the spinal column, a depression was observed opposite the fifth cervical vertebra. On pressing this part, the patient complained of acute pain. The respiration was carried on by the diaphragm alone, there being no motion of the ribs. Priapism. He was largely bled. On the second day, the patient was nearly in the same state, except that the upper extremities, were completely paralyzed. The respiration was more and more difficult, and he died in a state of asphyxia in 24 hours more. Dissection-The cervical ligament was found to be torn, and there was a complete luxation of the fifth from the sixth cervical vertebra, without any fracture. At this spot, the spinal marrow was compressed by the fifth vertebra. The lungs were gorged with blood. It does not appear that any means were used to reduce the luxation. Would any means have proved serviceable? 36. CASE OF EMPHYSEMA OF THE SUBSTANCE OF THE HEART; WITH OBSERVATIONS ON VALVULAR DISEASE OF THE SAME ORGAN. A very curious case of this rare disease came lately under the care of Mr. Morrah, of Sloane Street, and was attended by that gentleman and Dr. Johnson. The patient was a captain in the Royal Navy, aged about 52 years, who had met with some misfortunes a few years ago, and afterwards began to evince symptoms of disordered action of the heart, namely, dyspnoea on going up stairs, and irregularity of the pulse. These symptoms gradually increased, till, at length, he was confined to his bed-room, though never to his bed. About four months ago, when examined carefully with the stethoscope, the heart was found to beat over a large, space, and to be very tumultuous and irregular in its action. The whizzing sound was also very audible, when the ventricles contracted. The contraction could frequently be heard through the stethoscope, when no corresponding pulse was felt at the wrist. Thus, when not more than 50 or 60 strokes of the pulse could be enumerated, and those very irregular, there might be heard 70 or 80 contractions of the ventricle. The respiration was audible in all parts of the chest, except in the region of the heart, which occupied a large space, and consequently prevented the breathing being heard in that quarter. At this time, there were alternate paroxysms of dyspnoea and calm breathing, the intervals varying from a few minutes to as many hours. The night, however, was very distressing, as he could not lie low in bed, and his sleep was disturbed by startings and sense of suffocation. There was nothing very particular in the other functions. His dyspnoea was generally relieved by bleeding, local or general, with blisters, aperient medicine, and low diet. The diagnosis was, enlargement of the heart, and imperfection of the valvular apparatus, without any material affection of the lungs. For two months before this unfortunate gentleman's death, his sufferings were very great, especially in the night. His time was passed in alternate paroxysms of dyspnoea, threatening every moment his life, and then sudden cessation of the attack, with an interval of complete freedom from all dyspnea. It was very curious to observe that the interval (for more than a month prior to death) was almost invariably twice as long as the paroxysm. Thus, if the dyspnoea lasted five minutes, the patient had a complete immunity for ten minutes afterwards. The accessions were, like the cessations, instantaneous. He would be conversing quietly with his wife, his children, or his medical attendants, and in the very midst of a sentence, or even of a word, he would be seized with such a panting for breath, that a stranger would suppose he was in articulo-mortis. Equally sudden and abrupt would be the termination of this terrible conflict; and then he would take up the sentence or the word where it had been interrupted by the paroxysm. Towards the close of the scene-that is, for the last three weeks of the patient's life, there were evident symptoms of effusion in the chest, as well as oedema of the lower extremities. Then the respiration could not be heard below the middle of the thorax, in the perpendicular position, though it was quite audible all round the superior parts of the chest. He suddenly expired while conversing with his daughter, in one of the intervals of dyspnoea, on the 23d of October, as he was sitting in his arm chair. The body was examined on the 24th, by Mr. Morrah, Dr. Johnson, and Mr. Stevenson, of the Edgeware Road. There was very considerable effusion, amounting to several pints, in the two sides of the chest. The heart was nearly three times its natural size-all its cavities being greatly dilated, but its parietes not being increased in proportion. The auricles were nearly of their natural thick ness, though their cavities were considerably augmented. The right ventricle was passively enlarged. Its parietes were thinner than natural, though its cavity was more than double its proper size. The cavity of the left ventricle was also more than double its usual dimensions, but the parietes presented certain remarkable appearances. In some places, they were full an inch in thickness-in others, not a quarter of an inch. Near the apex of the left ventricle, the muscular structure was white, and condensed into a substance almost as firm as ligament. Between this and the basis of the ventricle, there were some portions of |