"The only rule by which I would be, and have always been guided, is the following: A certain effect is to be produced, coute qui coute; and we must go on exhibiting opium in considerable doses, at such short intervals as are sufficient to permit its accumulation in the primæ viæ, until enough has been taken to produce sleep. I have generally given it every hour; but when sleep appears actually ap proaching, a somewhat longer interval may be allowed to ascertain the fact, without much hazard of defeating the plan of cure. If the case be a slight one, I have left doses amounting to five or six grains with the attendants, directing them to proceed with it, either until sleep was produced, or the medicine had all been taken. Upon the failure of one trial like this, a much larger amount must be employed; and where considerable doses are given at every time, it is indispensably necessary that the physician should superintend their effects himself, visiting the patient after every fresh administration, and watching for any disposition to drowsiness. Where this has not yet appeared, there is not the least danger to be apprehended; as we believe it may be safely denied that there is a case on record in which any injury was sustained."

Dr. Coates makes many judicious remarks on various other modes of treatment that have been recommended, and also on some auxiliary remedies that may be occasionally employed; but these we shall pass over. He also gives the corroborative testimony of several respectable American physicians, as to the efficacy of large doses of opium in delirium tremens-a practice which we believe to be the best and the safest that can be followed in this dangerous malady.

2. HOTEL DIEU.

CASE OF HYDATIDS OF THE LIVER CURED

BY OPERATION. By M. MARTINET. It is now well known that the hydatids, whether they be morbid growths or living animals, invade almost every structure in the human body. They vary according to the part in which they grow. Those of the liver are enclosed in a cellular or

fibrous cyst, developed at the expense of the cellular tissue of the organ, and are found floating in a liquid, sometimes serous and clear-sometimes puriform and turbid; the latter probably from inflam mation occurring in the parietes of the cysts. In proportion as the cysts expand, the larger hydatids burst--their debris become mixed with the fluid-and the fluid itself acquires a turbid appearance. We are nearly in the dark as to the causes of these hydatid formations in the liver. They have been observed more frequently after contusions of the right hypochondrium than under other circumstances; but these cases are far from proving the etiology of the disease. Like all other organic diseases of this viscus, hydatids produce little or no inconvenience till their size begins to disturb the function of the organ, and occasion an enlarge. ment of the right hypochondriac region, Even then, it is next to impossible to diagnosticate with any degree of certainty. When there is a prominence, accompa nied by a fluctuation, we may conjecture, with some degree of probability, that there is either an hydatid formation, or a collection of purulent matter-in either of which cases we imagine there can be little objection to an operation. We shall now proceed to the case under consideration.

Case. A ship-painter, named Damenge, aged 20 years, of strong constitution, and who had enjoyed habitual good health, with the exception of some attacks of colic, fell from a stage, on the 26th April, 1827, to a distance of ten or twelve feet, and was picked up insensible. On the next day, a slight yellow tint was perceived on his countenance, which soon spread over the whole surface of his body; but, as his health was not affected, he returned to work on the 28th of the same month. On the 30th he felt pain in the right hypochondrium, and he could not lie on either side in bed. The pain in his side was accompanied by a retraction of the corresponding testicle, to which were added thirst and fever. This state continued till the 3d of May, when he was received in the HOTEL DIEU.

There was now very little fever-a slight yellow tint pervaded the surface of the body-tongue scarcely white-no head-ach-no pain in the right shoulder

-constipation during the last four days. In the right hypochondrium, there was a tumour, of irregular form, but not lobulated, extending from the ensiform cartilage to the edges of the false ribs, (which were a little raised) downwards to below the umbilicus. Pressure produced but little uneasiness, and the sense of touch discovered the presence of several bodies, somewhat hard, salient, unequal, and pulsative. The pulsation was considered as communicated from subjacent vessels. In several points, an obscure fluctuation was perceptible. Percussion elicited a very dull sound from the whole of the upper and right side of the abdomen, down as low as the right flank. On striking various points of the abdomen with one hand, while the other was kept steadily on the tumour, no shock was communicated to the latter. The application of the ear to the parts communicated no sound-but rather an absence of all sound. Venesection-low diet.

On the 4th May, a very fine trocar was introduced into the part where fluctuation had been least equivocal, and a cupping glass applied. A few drops of limpid fluid escaped by the aperture. During the succeeding days, the health of the patient improved, and the icterus diminished. A caustic of potassa fusa was applied on the most salient point, under the false ribs-this was repeated on subsequent days. Mean time the tumour seemed to get flatter, and lessened in volume. On the 15th May, the eschars fell off, and on the 19th, the tumour opened spontaneously into the bottom of the wound, and discharged a great quantity of yellow fluid, containing numerous hydatids. The diameter of the opening was about half an inch. Three basins were quickly filled with this discharge, and innumerable hydatids, of various sizes, up to that of an egg, (elongated in passing,) were disgorged, with great diminution of the volume of the abdomen. The majority of these acephalocysts presented transparent coats, two or three in number, containing an aqueous fluid, which soon turned opaque, on being exposed to the air. During the next few days there was a considerable discharge of hydatids, and the patient continued free from fever. Some mild fluids were injected, from time to time, and returned nearly colourless. The hydatids that issued on the 23d of May were of a yellow colour, apparently tinged with bile. The

tumour had greatly subsided, and a pretty tight bandage was kept round the abdomen. The injection returned this day, rather fetid in odour. 26th. The injection returned much less fetid. In the course of the following days, an injection, composed of decoction of bark and solution of chloruret of lime, was employed, and produced some smarting pain. On the 5th June, a slight diarrhoea came on, which was remedied by a more restricted diet. On the 11th June there could not be more than four ounces of injection thrown into the cyst; and, by the 22d of the same month, it was impossible to introduce any thing. 5th July. A slight discharge of purulent matter takes place every day, and the wound is closing fast. On the 6th July, the discharge presented the odour of feculent matter; and, next evening, some fragments of peas, eaten at dinner were unequivocal in the discharge from the wound. From the 8th till the 20th of the same month, portions of undigested aliment presented themselves among the discharge, which was always of a stercoraceous odour. Sutures were tried to close the fistula, but they failed. On the 30th, the patient left the hospital, in perfect health, with the inconvenience, only, of a small stercoraceous fistula. In the early part of August, he presented himself at the HOTEL DIEU, with the fistula completely cicatrized, and his health excellent.

M.

he was much gratified at the success of that surgeon's treatment of stricture of the lachrymal duct. The operation consists in the simple insertion of a metallic tube into the lachrymal canal, over which the integuments are to be healed. Dupuytren is said to be successful in nineteen out of twenty cases. The canula which is of silver, gold, or platina, is one inch in length-its upper opening measures one tenth of an inch-the tube gradually tapering from its upper to its lower opening, the diameter of which measures one twentieth part of an inch. The lower opening is placed obliquely, and the upper one is surrounded by a small rim, to prevent its sinking too low into the duct. The surgeon having punctured the lachrymal sac with the point of a bistoury, inserted close below the tendon of the orbicularis palpebrarum, leaves the instrument there as a director, till the canula is insinuated along it into the lachrymal canal. The bistoury is then withdrawn-slight pressure is made upon the upper part of the canula, so as to imbed it in the canal-and the opera tion is completed. The patient is then directed to blow down the nose, at the time that pressure is made upon the nostrils, by which the tube is freed from any blood that may have accumulated in it, while the air issues out at the incision, showing the free communication established between the nostril and sac. Teale has detailed some cases of his own, successfully treated upon M. Dupuytren's plan.

Mr.

ON THE COMPARATIVE RESULTS OF AMPUTATION IN MILITARY AND CIVIL HOSPITALS, AND ON THE FIELD OF BATTLE. By M. SANSON, Surgeon of the Hôtel Dieu, Paris.

It is a common remark, that amputations succeed better in military hospitals, and on the field of battle, than in civil hospitals. This is true, generally speaking. But what, says M. Sanson, are we to conclude from it? Is this superior success owing to greater dexterity in the operator, or a better mode of operating, or more care afterwards? We agree with him, that such a conclusion would be unfair, as well as erroneous. The difference of results, then, he thinks, are to be

The soldier,

4. Moral Dispositions. says, M. Sanson, marches into the field of battle at the risk of life, and, therefore, thinks himself well off with the mere loss of a limb. In other respects, he is free from care or anxiety. A pension, or a domicile in some place under government, insures him an honorable existence. He submits not only cheerfully to amputation, where it is necessary, but even cuts jokes on the occasion. If he loses a leg, he saves half the expense of shoes and stockings! The moral frame of the artisan's mind is in a very different condition, when doomed, in a civil hospital, to the loss of a limb. Worn out with penury and disease before he enters the hospital, he sees all his hopes of a cure vanish into air, and finds himself obliged to undergo an operation, that deprives him of a member which he can ill spare, in gaining a subsistence, or maintaining a family. It is no wonder that this depressed condition of the mind takes away all chance from the body, and often renders him the victim of an operation, however well performed.-REPERTOIRE.

M. Sanson has overlooked one very important cause of the difference of success in this and other operations, equal in themselves;-namely, the difference of

air in a civil hospital, and in a camp, or military hospital. The two last situations possess infinite advantages in this respect over even the best provincial hospitals: and, if so, how much more salutary must they be than the smoky, and malarious hospitals of a metropolis!

3. HOTEL DIEU DE ROUEN.

EFFECTS OF FEAR. M. HELLIS.

Many curious instances are on record of the effects (some of them fatal) produced by sudden emotions of the mind. Barthez relates the case of a woman, who, having let fall her infant child, was instantly stricken with paralysis of one of her arms. M. Hellis lately witnessed a somewhat similar incident. A young girl, 12 years of age, having had the curiosity to be present at an execution, against the consent of her parents, was so horrified when the criminal's head was struck off, that she immediately became paralytic of one arm. She was under treatment three months at the Hôtel Dieu, without the least relief, and has since been discharged uncured. This girl evinced not the slightest indisposition, in any other respect, and M. Hellis thinks that, had she died immediately after the paralytic attack, no structural cause of the paralysis would have been found. We are by no means so certain of this. He attributes the production of paralysis, in such cases, to a kind of spasm or convulsion-and compares the accident to one of those violent mental emotions, where the individual's voice is instantly taken away, the respiration rendered short, and the heart's action disturbed. Further, he compares the paroxysm of terror to a concussion of the brain, which bereaves the individual completely of power for the time, or even destroys life, without leaving any appreciable lesion of structure, on dissec

eyes wandered without any fixed regard― all voluntary movement was abolished, but there was no rigidity, nor did the members appear to be in a state of common paralysis. Deglutition was very difficult. An emetic was administered, and produced some trifling effect, and, next day, some leeches were applied to the neck, without any benefit. On the fourth day she suddenly expired.

Dissection. The dura mater and arachnoid appeared perfectly healthy. The brain was carefully sliced, but presented no alteration or morbid appearance. The ventricles contained a very small quantity of limpid serum, and their lining membrane was healthy. The cerebellum was sound, as were the contents of the spinal canal. The lungs, the heart, the liver were healthy. The gall-bladder was full of green bile. The stomach was unaltered. The pharynx was the only part that offered traces of inflammation, and that to no great extent.--BIBLIOTHEQUE.

The foregoing is certainly a very striking instance of the powerful influence of mind over matter. The longer we live, the more are we convinced that a great the etiology of physical causes in our many disorders and diseases ranged under nosological books, are produced by emo.

tions of the mind.

The following interesting cases have been officially published from the CLINIQUE of the above hospital.

Case 1. (Pneumo-thorax.) H. Bornier, aged 22 years, had been affected, for a considerable time, with varices and varicose ulcers of the legs, and for two years past he complained of pain in the chest and difficulty of breathing. His digestion was bad-his legs were cedematous-he had very strong palpitations of the heart -and he could take no exercise without danger of suffocation. His pulse was full, hard, and quick. In this state he was received into hospital, on the 13th June, 1827. He coughed much, and expectorated a yellowish flocculent matter-complained of deep-seated pain between the

1

shoulders. By leechings and low diet these symptoms were considerably miti gated; but on the 18th fever was rekindled, with pain in the right side of the chest. Leeches, aperients, and diluents again employed; but without the dyspnoea-the muco-purulent expectora tion-the quickness of pulse went on;and, on the 25th, the parietes of the chest appeared elevated-little or no respiratory sound could be heard in the right side, which, on percussion, was very sonorous, and salient. He went on in a wretched condition till the 29th, when he died.

Dissection. A trocar was pushed into the right side, when a large quantity of air rushed out. On opening the chest, the right lung was found compressed against the vertebral column-its lower portion and also the diaphragm were covered with false membranes-five ounces of transparent fluid in that side of the chest. The fistulous opening in the lung was found near the summit, and communicated with a very small cavern in the superior lobe. Through this fistula the air escaped and produced the pneumothorax. There were many crude tubercles in the lungs. The mucous membrane of the trachea was much inflamed, and covered with muco-purulent secretion. All the other parts were sound.

Case 2. (Disease of the Heart.) Eliza Beaugrand, aged 17 years, of pallid complexion, and delicate constitution, fell down about two months previously, deprived of sense and motion. From that time, till her entry into hospital, (15th June,) the extensor muscles of the left hand remained paralytic, notwithstanding the use of strychnine. On the 17th the paralysed hand was much infiltrated -18th, the lower extremities were observed to be cedematous-and, on the 20th, the state of the heart was examined. She had never experienced palpitationthe action of the heart was rather strong

and the whizzing, or bellows noise, (bruit de soufflet,) was loudly heard by the ear. On the 22d, when the hand was placed on the region of the heart, a trembling sensation (fremissement) was felt, which it is difficult to describe, but which can never be forgotten after being once felt. In the beginning of July, the dropsical infiltrations, and the bellows

sound increased-and bronchitis was added to the other disease. There was complete orthopnoea. She died on the 14th July.

Dissection. On one side of the right olfactory nerve, there was found a purulent depot, an inch and a half in length, by three lines in depth, containing white matter, intermixed with granulations of more firm consistence. The auriculo ventricular valves of the heart were indurated -one being of a fibro-cartilaginous texture, the other partially ossified.-Journ, Gen. de Medecine.

Remarks. It is very uncommon to find an apoplectic and paralytic affection in a person so young, and of such a constitution as the above female. It is still more rare to see induration of the mitral and tricuspid valves at the age of 17 years. The trembling sensation conveyed to the hand, in such cases, is very remarkable -but the noise of the heart's action, as heard through the stethoscope, or by the naked ear, is still more striking. We have compared it, on other occasions, to the noise made in churning-and, in fact, the valvular imperfections above described, do actually produce a tumultuous motion of the blood in the different chambers of the heart, resembling the motion of milk in a churn. At every contraction of the ventricles a portion of blood is ejected into the arteries, while another portion regurgitates into the respective auricles. This is a terrible disease; the sufferings which it occasions in the animal economy are dreadful; and death is the greatest blessing that can come on the wretched patient! These sufferings are often aggravated by ignorance of the real nature of the malady-a malady which we maintain can only be ascertained by proper examination of the chest. Let those who neglect or obstruct the study of auscultation, ponder on the responsibility which they incur by their conduct -and let them, moreover, be informed, that all their neglect and obstruction of the said study, will have no ultimate effect in preventing the cultivation of a physical mode of diagnosis, which is almost the only one, in pathology, that is not imbued with error!