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The ointment is to be applied but once a day, with a small brush, dipped in it, and applied between the eyelids; if it has the right consistence, it gets by the movements of the lids, diffused over the whole conjunctiva and cornea, and then by the - same agency extended from the eye, it should then be wiped off, lest it, by remaining too long in contact, create an undue irritation. If the movements of the lids are insufficient to completely remove it from the conjunctiva, we may effect this by rubbing them together, and raising both the upper and lower lids from the globe. Cold applications after its use generally very quickly subdue the first somewhat violent signs of irritation. If the eye still exhibits any irritation after one or two hours, it disappears after a walk in the open air.”

John C. Agnis, M. B., F. R. C. S., Assistant Surgeon Royal Horse Guards, on the treatment of Hydrocele by pressure after injection. (London Lancet, August number, 1865.)

After operations for hydrocele, there always remains a certain amount of deformity of the testicle and neighboring tissues. The author of the following treatment has found in his practice that pressure applied in the way usual for orchitis, restores the testicle to a consistency nearly normal. His plan is this, "having tapped a

“ the hydrocele, and injected a solution of iodine, he waits till the tenderness has subsided enough for the patient to bear without pain a degree of pressure equal to that produced by strapping. Then he applies the strappings in the way generally done for orchitis; some times the swelling diminishes so fast that the strappings have to be re-applied every second day. He thinks the earlier they are applied the better, provided the inflammation has subsided enough for it to be done without pain.'

Samuel Wilks, M. D., Assistant Physician to Guy's Hospital, on Epidemic Cerebro-Spinal Meningitis. (Lancet, July number, 1865.)

The author of this article, remarks that the three maladies prevailing in Russia, may be found hereafter to have the same origin, and that one of them, "meningitis spinalis," has prevailed in various parts of Europe and America for many years, in which the main symptoms as well as the deaths were due to an inflammation of the brain and spinal cord. “The petechiæ would denote a

OL 5, NO. 1-4,


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blood-disease, and therefore the cerebro-spinal meningitis may be only one of the usual concomitants; since recovery often took place, and an inflammation of the nervous centres is an almost necessarily fatal affection, it can scarcely be regarded as an essential part of the disease. From amongst the author's reports of post-mortem examinations, he records three cases of this disease as occurring suddenly in persons previously comparatively healthy. According to the modern doctrines of pathology, a healthy person cannot be seized with a simple idiopathic inflammation of this kind, it is probable that in these cases there were some accompanying blood-disease, of which the cerebro-spinal meningitis was the most marked outward evidence.”

Dr. W. T. Gairdner, Professor of Medicine in University of Glasgow, on Typhus Fever. (Braithwaite's Retrospect, July, 1865.)

“In a large proportion of cases, typhus fever left to pursue its natural course, and treated with milk diet and without drugs or stimulants, will have its natural crisis before the twelfth day. No other food can be depended on but milk or buttermilk; to give wine, whisky, and beef tea, while withholding milk is to diminish the chance of the patient's recovery. Large doses of alcoholic stimulants are positively injurious, as is also the deprivation of fresh air. Our guide to the progress of a case of fever is, to watch carefully and constantly the rate of the pulse, for it gradually rises in frequency up to the acme of the fever, and then as gradually declines, so that the crisis can be accurately ascertained. This is of immense importance as regards the prognosis, for the other symptoms may continue as formidable as ever, but if the pulse is gradually declining in frequency, the case will do well.”

Frederic H. Morris, M. D., case of Recurrent Fibroid Tumor. (Lancet

, May number, 1865.) A brick-maker, aged 42, consulted Dr. Morris about a tumor in the neck. On examination a tumor was found in the parotid region, about the size of a walnut. As his general health was good, removal was recommended. In about ten months he again presented himself; it was now about the size of a lemon, adherent to the fascia of the neck, but the skin was quite movable. anxious to have something done, and the operation was performed. No vessels were wounded; the wound healed by first intention,

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and the patient experienced considerable relief. In a short time another tumor appeared, which rapidly increased in size, and he sank exhausted with pain, etc., about five months after the operation.

On examining the tumor after removal, it presented externally a firm fibrous appearance, the interior was soft and pulpy. In structure the hard parts were essentially fibrous; many of the fibres appeared made up of cells, closely applied together, and in the soft parts isolated cells and nuclei abounded.

The recurring fibroid tumor forms a kind of connecting link between the innocent and malignant formations, and it is an important circumstance that the later-produced tumors approximate much more in appearance and behavior to the malignant character than the original.


Spotted Fever without Cerebro-Spinal Meningitis. By James J. Levick, M. D., one of the Physicians of Pennsylvania Hospital. At the present time, when the true nature of the so-called “spotted fever” is exciting much discussion, both at home and abroad, the following notes of a case of this disease coming under the writer's care may not be uninteresting:

During the prevalence of the epidemic of spotted fever in this city in the early part of last year I was called by my friend, Dr. Scholfield, to see Ellen C-, a tall and robust Irish woman, residing near Eighth and Filbert streets. She had been detained at a restaurant, where she was employed as cook, until a late hour of the preceding night. She went to bed at 2 A. M., apparently as well as usual. During the night she was seized with a chill, nausea and vomiting. This latter continued throughout the night. She was seen by Dr. Scholfield at about 10 o'clock in the morning, and a few hours later by the writer, and presented the following appearance: she was sitting up, gave the history of her attack as noted above, said she had no pain in her head, but complained of ment for the reception of sick and wounded soldiers, will readily explain the large number of cases of gun-shot wounds and chronic diarrhea. A purely civil hospital would not 'be likely to receive so great a number of such cases. These groupings, as given above, are in some cases too general, and need more detailed statement. It will be seen, debility covers a large number, in which a definite diagnosis was not or could not be arrived at, making the statistics somewhat indefinite and less valuable.

All such grouping is objectionable, and should be, as much as possible, avoided. Of course, in many cases an autopsy is the only thing which will clear up satisfactorily an obscure case, but modern methods of diagnosis are competent to make, if well employed, a more definite classification. The same objection lies against so general a term as dropsy, though it is very probable that it is used as but another term for ascites.

CAUSES OF DEATH. Abscess, Psoas.............

1 Fracture, Foot and Ankle, compound (after Cancer of Uterus..

1 Amputation). Concussion of Brain..

1 Hospital Gangrene. Debility

2 Old Age Delirium Tremens.................

1 Pericarditis Diarreba, Chronic.... ......

4 Peritonitis. Dropay..

1 Phthisis.... Dysentery

2 Pleuritis, (1 empyæma,) Epilepsy, (after (trephining,

1 Poeumonia Fever, Typhoid..

2 Pyænia.... Fracture of Skull....

1 Valvular disease of Heart....


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Amputations.—Twenty-eight amputations are recorded-without explanation this would convey a wrong impression. The amputations were not all made at the Hospital. In most cases, this had been done before the patients were admitted. The cases were mostly soldiers, some of whom had undergone the operation on the field, and some in other Hospitals. They were, therefore, received for treatment after amputation. The cases of amputation actually performed at the Hospital, will be spoken of separately. With this explanation, the cases of amputation were-of the thigh, four; of the arm and forearm, nine; of the leg, ten; of the foot, one; of fingers, four.

Cancer.—The cases of cancer werė, of the breast schirrus, one, removed; one of the os uteri causing death, in a woman about 45 years of age; one of the testis, medullary, in a young man, thirty years, removed; and lastly, a medullary cancer on the outer and upper part of the thigh in a man about 50, which was not interfered with, as it had so far involved the neighboring tissues as to offer no prospect of benefit by removal.

Diseases of the Eye.-Conjunctivitis, nine; ectropion, two; melanosis, one; injury (gun-shot) causing loss of sight in both eyes, one; iritis one, catarrhal ophthalmia, one; opacity of the cornea, two.

Fractures. The fractures were of the clavicle middle third, one; lower jaw comminuted, one; femur middle third, one; fibula alone, one; tibia alone, one; tibia and fibula both, three; humerus, two; patella, two; ribs, two; skull, one. The fracture of the clavicle was caused by a direct blow upon the shoulder, and there being considerable obliquity and overlapping, the result was rather more than the average deformity, though the pad and sling were employed, and the patient made very uncomfortable by the complicated retentive apparatus. The fracture of the femur was treated by extension by means of weights and without a long side splint; the leg and thigh being propped by pads. Short splints were employed. The counter extension was obtained by elevating the lower end of the bed by means of a block three or four inches in thickness. In addition, a board foundation upon which the bed rested was hinged near the middle, so that both feet and head could be elevated. On the inclined plane thus formed, at the lower end, the weight of the body gave sufficient counter extension. The weight employed never exceeded thirteen pounds; and was for the greater part of the time less than ten pounds. It was attached to a cord which played over a pulley fastened by means of a frame to the foot of the bed. The result was satisfactory, the shortening being less than half an inch. This apparatus proved more comfortable to the patient and more easily managed, than any heretofore employed.

Paralysis.-Of these, six were cases of paraplegia, four of hemiplegia, one of paralysis of the facial nerve which was caused by exposure to cold air.

These cases of paraplegia illustrated some of the points of differential diagnosis. One was in connection with angular curvature or Pott's disease, and in this case the control of the sphincters was not lost, confirming the statement of Romberg that paralysis from affection of the bones of the vertebral column spares the

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