done in all cases where it is practicable. Hence I divided the soft parts around the projecting portion of the jaw, and with one stroke of a strong cutting forceps separated the bone on a level with the lateral pieces of the maxilla. The bleeding, which was considerable from the anterior palatine artery, was soon stopped by pressure with the finger. The edges of the lip were separated from the alveolar process of the jaw and placed in the usual manner, after which they were nice. ly adjusted to each other, and kept there by two stitches with a single thread of uncolored silk. Adhesive straps, and the usual compress and bandage over the cheeks finished the dressings. No untoward symp. toms followed, and in five or six days the union of the lip was perfect, allowing all dressings to be removed except a single strap of adhesive plaster to support the yet tender union of parts. And, though the operation produced a vast improvement on his former appearance, highly gratifying to his parents and friends, yet it showed very plainly the shorten. ing of the upper jaw by the excision, and consequently the want of that natural symmetry of the features which is so desirable; and which might have been produced with perfect ease, if the operation had been performed before the first six months of the child's existence had passed. For then, the yielding condition of the bones would readily have permitted the projecting portion of the jaw to have been depressed, and the lateral parts of the lip brought over it, thereby preserving the full length of the jaw, as my own experience in the very worst of cases, has abundantly proved. It was, indeed, for the purpose of enforcing this and one other point of minor importance, that I presented the foregoing case, and not from any intrinsic merit in the case itself. For though the advantages of an early operation seem to be duly appreciated by all good surgeons of the present day, yet it is far different with the profession generally in the country. With them the cautions of Sir Astley Cooper, the equivocal advice of Samuel Cooper, and the positive instructions of Liston, Druitt, &c., prevail. And hence a large majority of these unfortunate children are left until they are two or three years old, to the great detriment of the patient and annoyance of its friends. The positive advantages of an operation between the ages of three and six months are, first: the ability to mould the alveolar process of the jaw into any desirable shape by judicious pressure, and consequently the ability to preserve its full length and proportions. Second, the much more rapid filling up of the roof of the mouth, when the fissure or fissures extend through the palate, &c. Third, the abili ty to acquire the power of speech or articulation of sounds much more perfectly. And fourth, the absence of all dread or opposition to the performance of the operation on the part of the child. The only offset to these important advantages is the possible occurrence of convulsions from the operation at so early a period. And even this danger, I am satisfied, has been much exaggerated, as the practice of Ledrun, Bell, Mays, Roonhuysen, Pancoast and many others plainly show. I have operated on three children under the age of six months, with the most perfect success. And decidedly the worst case of the three, which presented a double fissure extending through the roof of the mouth and palate, with the middle piece of the jaw projecting even with the end of the nose, was operated on, at the age of two months, without being followed by the slightest unfavorable symptoms. Another point

about which there still seems to be a difference of opinion among good surgeons, is the propriety of using pins for keeping the edges of the lip in contact. When operations of this nature first came under the notice of the surgeon, it is not surprising that some unusual and complicated plan should have been deemed necessary, to retain the parts in their proper position. But since experience has so abundantly demonstrated the greater safety, simplicity and success, of the simple interrupted suture, and an adhesive strap, I was not a little surprised to find the pins, both pictured and advocated in the splendidly illustrated work of Prof. Pancoast. It is true that the pins already inserted, with the thread nicely coiled around them, make a fine looking picture on paper, but the increased irritation which their pressure produces, the greater difficulty of withdrawing them, and the far greater danger of their being accidentally disturbed by the child, have always induced me to give the interrupted suture the preference in my own practice.

ART. V.-Successful Amputation at the Hip-Joint. By MOSES SWEAT, M. D., of Parsonsville, Maine.

THE patient upon whom this operation was performed was about fortyfive years of age. Some time in 1832 he received a severe injury upon his left knee from which he never recovered. In 1842, ten years after the injury, he called in Drs. S. and J. M. Blake, who upon examination of the limb, found the knee-joint somewhat enlarged and an ab. scess formed upon the inside, just above the joint, which being opened, discharged half a pint of thick pus. In February, 1843, the limb was amputated by Dr. Grover, about four inches above the knee-joint.

In July, 1843, Drs. Blake, Barrows and Tewksbury were called in consultation with Dr. Grover, upon the propriety of another amputation. There was some inflammation in the limb and great enlargement and induration from the deposition of lymph. There were two openings in the end of the stump, and two on the outer side four inches up the thigh, which communicated with tortuous sinuses extending to the groin. The stump was laid open a few inches to ascertain the condition of the bone, which was found in a softened state, the medullary substance being destroyed to a great extent. The patient's health had materially suffered and there were symptoms of hec. tic. The discharge from the sinuses was moderate in quantity, consisting of thick white pus. The consulting physicians were all of opinion that the amputation should be performed as high as the trochanter major. Dr. Grover however supposed that but a small portion of the bone was diseased, and contrary to the advice of the consulting phy. sicians removed but about three inches of the bone which was so soft as to offer but little resistance to the saw. The patient was so much exhausted at that time that another operation could not be performed. After the stump was dressed the sinuses continued to discharge as before and there was much inflammation about the groin and hip-joint.

On the 13th of January, 1844, I was called to visit the pa

tient, who was confined to his bed and had lain upon his back (for he could lie in no other position) for more than a year. He was extremely feeble and much emaciated, attended with hectic and night sweats, and also with severe pains which could be mitigated only by morphine.

Upon examination I found the whole thigh, one foot in length from the groin, a complete mass of disease. It was much enlarged, measuring thirty-six inches around the hip and groin, and twentyfour inches around the lower part of the stump. Three large sinuses were open at, or near, the end of the stump; two or three outside of the femur, extending to the trochanter major-and two or three inside extending under the fascia nearly to the groin-and there were other deeper sinuses following the interstices of the muscles nearly to the head of the femoris, and communicating with those large onesfrom all of which pus, indicating disease of the bone, was discharged in profusion.

After full examination I came to the conclusion that the only operation which gave any hope of success, was the amputation of the hip-joint. The Drs. Blake, who were in attendance, also advised this as the only hope of saving the patient.

When the patient had consented to the operation, he was placed on a table on his right side. It was deemed necessary in order to secure success in the operation, that all the diseased parts should be removed. When the sinuses were explored and their extent marked on the surface, it was found that the operation could not be performed according to any method recommended in any work on operative surgery, without retaining more or less of the diseased secreting surface in the wound. But by cutting in the following manner, a sufficiency of sound parts could be saved to completely cover the wound :-Commencing about two inches above the trochanter major towards the crest of the ilium, thence cutting down to the trochanter, (without removing any substance in order to make room to discharge the head of the femur), thence diverging inward in a circular manner so as to pass 21 inches below the groin and terminating in a point which, with the posterior incision, made from this point in a circular manner round the posterior part of the thigh, to the point of divergence of the inner incision, formed an angle of the side of the scrotum, equi-distant from the trochanter.

While Dr. S. Blake compressed the large artery on the pubis, I made an incision through the integuments and cellular structure to the fascia-the whole posterior or outer mass of muscular substance, &c., to the bone was then cut through, and the largest posterior artery secured; the head of the femur was next dislodged from the acetabulum, and the remaining substance on the inside cut off by one stroke of the knife, and the femoral and profundal arteries were readily secured. So firm was the compression by Dr. B., that scarcely an ounce of blood was lost. Several small arteries were then secured and the wound, eighteen inches in length, after it was closed, was secured by sutures, adhesive straps and the many-tailed bandage.

Though extremely feeble, Mr. Howard bore the operation without any complaint and seemed quite comfortable after being replaced on his bed. The parts removed were carefully examined and the bone taken out. It was partially denuded of the periosteum and softened

nearly its whole extent, and the cellular or cancellated structure was destroyed nearly to the trochanter minor. The wound was dressed on the sixth day after the operation, when the integuments were found to be united by the first intention the whole extent, except where the ligatures were left out at the inner angle. The patient regained his health rapidly and in a few months was able to go out. In the follow. ing November he rode alone in his carriage forty miles, to visit me at my residence, when he was as well as he had been previous to his illness.

ART. VI.-Urticaria produced by Hydrocyanic Acid.- By T. R. VARICK, M. D., New York.

THE subject of the following case is a child, aged 13 months, who was attended by me while laboring under an attack of acute bronchitis. The child had been taking the following mixture :

R Pulv. Ipecac. gr. v.

Mucil, Acacia 3ij.

M. a teaspoonful every hour,

which becoming exhausted, I desired it to be repeated; but owing to the druggist not having numbered it correctly, he substituted the following: ..

Acidi Hydrocyanici, (off) gtt. xx.

Tr. Belladonnæ,

Syrupi Tolutani,

Mucil. Acacia, áá.

Aq. distillat.

3 ss.

ss.

3 vijss.
M.

as I afterwards ascertained by reference to his file. The alteration in the medicine not being known, it was administered as before, when, after the first dose (a teaspoonful), the face, neck, and the outside of the arms became covered with well-marked Urticaria. I should have observed that the eruption appeared in about half an hour after the administration of the medicine, and that it subsided spontaneously in about an hour and a half after its appearance. The dose was repeated in the evening of the same day with a similar result.

Remarks. The child has always enjoyed perfect health, is of rather a plethoric make, and is nursing. The parents both healthy. It has never had any of the cutaneous diseases. The causes of Urticaria, as laid down by Cazenave and Schedel, are the handling of the leaves of the "Urtica divica," from ingestion of certain kinds of food, especially shell-fish of different kinds, as lobster, shrimp, crab, mussel, &c. Bitter almonds, mushrooms, cucumber, salad, and even oatmeal, vinegar, honey and certain medicines, such as turpentine, balsam copaiba, and valerian, also produce this disease, (Vide Cazenave and Schedel on the Skin, American edition, p. 54-55). It may be urged that the eruption was produced by the Tr. Belladonna, contained in the prescription, as it is well known to give rise to an eruption, resembling scarlatina, with swelling of the face, (Vide Pereira, Mat. Med.). But I am inclined to attribute it to the Hydrocyanic Acid, and for these reasons: 1. Urticaria may be produced by bitter almonds, and Hydrocyanic Acid is the active principle involved. 2. The entire difference of the

eruption occasioned by Belladonna and that which appeared in this case. It may also be urged that, as the child was teething, (a fact that I omitted to mention), the occurrence of Urticaria was a mere coincidence with the administration of the medicine. But this point is to my mind satisfactorily settled, by the following facts: 1. The patient, although teething, has never had anything of the kind, before or since. 2. By the repetition of the dose similar symptoms appearing. The latter reason is to my mind the most conclusive, and entirely does away with the idea of coincidence. Another thing worthy of remark, is the smallness of the quantity which produced the symptoms, as may be ascertained by reference to the prescription, to be a little more than a drop at a doze. The acid was of Scheele's strength.

ART. VII.-Remarks on the Alnus Serrulata, or Common Black Alder. By JAMES HELMICH, M. D., of Zanesville, Ohio. (Communicated in a letter to the Editor.)

Zanesville, Ohio, February 5, 1847. I NOTICED in the July No. for 1846, of the New York Journal of Med. and the Collateral Sciences, an article on Indigenous Medical Botany, by S. W. Williams. Among the indigenous medicinal plants named by Dr. Williams, and to which he has called the attention of the readers of your valuable Journal, is the "Alnus Serrulata" or common Black Alder. It is not my purpose to gainsay a word that Dr. W. has said in describing its medical use, nor am I certain that he has said all that he has to say about it; but I am sure he has not said all that should be said in its favour. Dr. W. has pointed out several uses of the Black Alder entirely new to me, viz.: repelling the milk in the female breast -the inner bark of the root being emetic-a decoction of the cones for the suppression of hemorrhage-and in hæmaturia.

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I have long been in the habit of prescribing a decoction of the Black Alder, and more recently of the extract (a more convenient and eligible form) in chronic affections, and more particularly in scrofula and secondary syphilis. I have seen some of the most happy results from its use in both these forms of disease. Mrs. Swas admitted into the county alms house, with secondary syphilis of long standing, and a constitution broken down with the disease and the use of mercury; she had ulcers in the nose and palate, nodes on the head, legs, and arms; and unable to walk from stiffness of joints; indeed she seemed to be a hopeless case. She was ordered a strong decoction of the Black Alder, and a milk and vegetable diet, to which she rigidly adhered for six months, when she left the institution perfectly cured, and remains well up to the present time, a period of three years.

A clergyman's lady of this vicinity had scrofula, with open ulcers, large and ill-conditioned; she was entirely cured by the use of a decoction of the Black Alder. This lady has removed a distance of a hundred miles from this place, and although cured, she continues to use it occasionally as a preventive; she has twice sent to this place to procure, as she says, the "genuine article."

I was acquainted with an intelligent old gentlemen, (since dead), who cured in his own person a cancer of the lip with a beer made from the bark and small branches of the Black Alder.