assigned to justify it was, that it could do no harm, because it would not salivate. Now it appears to me that no opinion can be more unfounded, and no practice more mischievous. Although a single dose of calomel, even though large, may be well borne by children of ordinary strength of constitution, yet even this is not entirely safe in all cases. And when these doses are frequently repeated, particularly in delicate habits, the most serious consequences may result.

3. The use of mercury in young subjects as an alterative, should in all cases be conducted with great caution. There is no practice more common than that of continuing the use of this agent in small doses, for a considerable time, and certainly none which is more liable to abuse. Under the idea that the dose is so small and from no salivation appearing, we are apt to infer that even if the medicine is not doing any good, it is certainly not doing any harm. Any im. provement, too, which occurs during the use of the article, is sure to be attributed to the silent operation of it on the system. Now although this is not unfrequently the case, yet it is not invariably so; and every observing physician must have been aware of cases, in which, in this way, the article has been unnecessarily and injuriously continued. In bowel complaints, under the idea of altering the secretions, it has frequently, no doubt, helped to keep up the very intestinal irritation which it was given to correct. In other cases it has developed the latent tendency to other diseases, such as Scrofula, Phthisis Pulmonalis, etc. In adults we know this to be very often the case. How much more likely is all this to happen in the young infant.

4. In the use of mercury in young children, great care should be exercised in ascertaining, as far as possible, their constitutional peculiarities. This, of course, is not in all cases easily to be done. A good deal, however, may be learned from an acquaintance with the tendencies of the parents. Whenever the parents show indications of scrofula, or where there is an hereditary predisposition to consumption, great caution ought to be exercised in the use of mercury in their offspring.

5. Mercury should be administered with great caution, in cases where a child has been sick for a considerable length of time, and when the strength of the child has been very much reduced. In this state of constitutional depression, a single cathartic dose of calomel sometimes proves fatal. We think we have seen more than one case, in which a child has been irretrievably prostrated under these circumstances, under the false impression that calomel is an innocent purgative to a child.

6. The too common practice of giving calomel as an ordinary purge, on all occasions, is certainly unjustifiable. From the facility with which it may be given, it is unquestionably resorted to in a great number of cases, where it is certainly unnecessary, and in a great number where it positively does harm. The misfortune is, that its use is not limited to an occasional dose, but it is too often given in every slight indisposition of the child. Now, in this way, there

can be no question that the use of it has laid the foundation for the ruin of the constitutions of thousands. It ought to be a rule laid down and rigidly followed, that in very young children, mercury ought never to be used as a cathartic, unless there is a special reason for resorting to it. In a great majority of cases, milder cathartics are decidedly to be preferred.

In concluding these observations, I trust it may not be supposed, that my intention has been to undervalue the importance of mercury as a remedy in the diseases of children. On the contrary, no one appreciates it more highly than myself. In many cases, nothing can supply its place, and its judicious use has been, and is, the instrument of saving multitudes of lives. Notwithstanding, however, the many cautions to the contrary, it is to be feared that the use of it is still too general and indiscriminate. Indeed, the amount of it which is taken by the human race in one way or other, is incalculable. What is given by regular physicians, is perhaps the smallest quantity. If the public really knew how much of this article is swallowed unknown to themselves, in the shape of bilious pills, worm lozenges, and the white powders of the Homeopaths, they would be amazed at their credulity in deserting their old medical advisers, because they have the boldness to give them an occasional dose, and the honesty to tell them so.-New York Annalist.

Remarks on Strangulated Umbilical Hernia, with a Case, by A. J. WEDDERBURN, M. D., Professor of Anatomy in the Medical College of Louisiana.—Strangulated umbilical hernia, being an affection of very rare occurrence in the adult male, it is deemed proper to report the following case for which a successful operation has been performed.

A negro man of 300 pounds weight, aged 31 years, the property of Dr. Slone, residing about two miles below New Orleans, states that he has always had an umbilical hernia, easily reducible, and about the size of a hen's egg-was attacked with a pain in the abdomen-found the tumour enlarged-attempted its reduction, but failed. I saw this case about 12 hours after the strangulation occurred, and found the tumour about the size of a child's head, very tense and elastic. About three hours before I saw the case Dr. Slone had used the various means recommended for reduction in such cases, and on my visiting the case with him, we further endeavoured for the space of an hour, to effect it by taxis, and to aid in the attempt we administered tartar emetic, tobacco injections, large injections of cold water with a hydrostatic injecting tube, and applied ice and sulphuric ether to the tumour. These efforts having failed, we determined upon an operation as the only means calculated to afford the patient a chance for his life. A short time previous to the operation, whilst making forcible taxis, considerable portion of gas contained in the incarcerated bowl escaped with a gurgling sound, and the tumour seemed to subside so rapidly under my hand, that I was induced to believe that I had succeeded in the reduction, but in a few minutes was con

vinced that the intestine could not be returned, or even the escape of more of the gas effected. By this effort the tumour was reduced so much by the escape of air from the intestine, and the tension consequently so much relieved, as to lessen the danger of wounding the intestine in dividing the integuments. We informed the patient of the necessity of an immediate operation, to which he somewhat objected, and only consented after we had allowed him to make an effort at reduction himself, which he continued for something like ten minutes, using all the while considerable and well directed force, for he had returned the intestine so often himself when the hernia was smaller and reducible, that he had acquired quite a degree of dexterity in the matter.

Operation. An incision was made upon the top of the tumour three or four inches in length through the skin in a vertical direction, so as to expose the superficial fascia, which was considerably condensed. A small opening was made through the fascia at the lower part of the wound, by light and careful touches with a scalpel, into which a director was introduced, and carried to the upper part of the first incision, and the fascia divided to correspond with the same, with a probe pointed bistoury. I then introduced my finger between the peritoneal sac and the superficial fascia, and carrying it in every direction, easily effected the separation of the two membranes. Finding there was not room to work in, the wound was enlarged by extending it about an inch above, and more than an inch below,-this enabled me to turn aside the integuments, and obtain a good view of the sac, which contained, floating in a nearly transparent fluid, a large portion of the omentum, and as well as I could determine, about fifteen inches of the small intestinal tube, which appeared to be perfectly black. A small opening was next made in the lower part of the sac, by seizing up a small portion of it with a pair of artery forceps, and carefully cutting in a horizontal direction. After the escape of about four or five ounces of fluid, a director was introduced, and the sac divided upon it about four inches. In a few moments the intestine, which presented the dark colour before mentioned, began to assume a red appearance, from the action of the air acting upon the blood contained in its vessels, through the coats of the intestine; from which circumstance, and also from a close examination, I was convinced that the gut retained its integrity, and at once endeavoured to return it by an attempt to kneed in a small portion at a time;-but in my efforts I not only failed, but additional portions of the omentum and intestine were forcing themselves from the abdomen. In order then, that the stricture could be arrived at without endangering the gut, it became necessary to extend the incisions, not only in the integuments nearly to the base of the tumour, but also in the peritoneal sac. The finger was then forced into the umbilical ring, and a probe pointed bistoury passed by its side, with which the structure was divided at the lower part about the fourth of an inch. An attempt was again made to return the bowel, but without success, when a division of the ring was made at the upper part, less

than a fourth of an inch in extent, by which means I was enabled to return the bowel by pushing in a small portion at a time. After returning the intestine, the omentum was returned, and spread out in front of the small intestines, as well as it could be done by the introduction of my finger into the cavity of the abdomen for this purpose.

After returning the contents of the sac, the blood was sponged from the wound, then leaving it open for the space of about 15 minutes, in order that the oozing from the divided vessels might be entirely arrested, the edges of the wound were brought in contact, and three interrupted sutures applied. The skin, which was very loose, was gathered up like a bag, with the sack contained within, but not included in the ligatures, and a graduated compress applied, with the hope that the mass would, if healed, be a barrier to a further protrusion, and effect a radical cure.

The operation was performed on the 23d of September last, and the patient recovered without a bad symptom. Small doses of calomel and opium were administered during four or five days. In ten days after the operation the patient walked across the room and is now entirely well, a radical cure having been effected.

As the operation just described differs somewhat from those recommended by different surgeons, I have thought proper to give below a few extracts, with some general remarks on the subject of exomphalos.

In Cooper's Surgical Dictionary we find the following: "In consequence of the great fatality of the usual operation for the exomphalos, I think the plan suggested and successfully practiced by Sir A. Cooper in two instances, should always be adopted when the tumour is large and free from gangrene; a plan that has also received the high sanction of that distinguished anatomist and surgeon, Professor Scarpa. (Traité des Hernies, p. 362.) Perhaps I might safely add, that when the parts.admit of being reduced, without laying open. the sack, this method should always be preferred. It consists in making an incision just sufficient to divide the stricture, without opening the sack at all, or, at all events, no more of it than is inevitable."

In umbilical hernia, of not a large size, Sir A. Cooper recommends the following plan of operating: "As the opening into the abdomen is placed towards the upper part of the tumour, I began the incision a little below it, that is, at the middle of the swelling and extended it to its lowest part. I then made a second incision at the upper part of the first, and at right angles with it, so that the double incision was in the form of the letter T, the top of which crossed the middle of the tumour. The integuments being thus divided, the angles of the incision were turned down, which exposed a considerable portion of the hernial sack. This being then carefully opened, the finger was passed below the intestines to the orifice of the sack at the umbilicus, and the probe-pointed bistoury being introduced upon it, I directed it into the opening at the navel, and divided the linea alba

downwards to the requisite degree, instead of upwards as in the former operation. When the omentum and intestine are returned, the portion of integument and sack which is left, falls over the opening at the umbilicus, covers it, and unites to its edge, and thus lessens the risk of peritoneal inflammation, by more readily closing the wound.

In Gibson, page 128, we find the following: "Strangulated umbilical hernia very frequently proves fatal, as much from disorder of the intestinal function as from the strangulation. When the usual remedies fail, an operation should be resorted to. This may be done in the following way. An incision, several inches long, is made very cautiously through the integuments and superficial fascia, when the sack, if not absorbed, as it often is, will appear. Into this a small opening should be made, from which fluid in considerable quantity generally issues. The opening may then be enlarged, and a finger carried upwards between the omentum and intestine as high as the umbilical ring. Upon the finger a bistoury is next to be carried through the linea alba, to the extent of an inch, which, in most cases will relieve the stricture sufficiently to enable the operator without much difficulty to restore the parts to their former situation.

"Dr. Physick has proposed, in strangulated umbilical hernia, to make a crucial incision through the integuments, as far as the neck of the sack, then open the sack at its upper part to an extent sufficient to enable the operator to examine its contents, and reduce them, if possible, without dilating the umbilical ring. Should the latter expedient, however, become necessary, the stricture must be divided on the outside of the sack. After the omentum and the intestine are restored to the abdomen, a ligature should be drawn around the neck of the sack, with a view of closing the cavity and obviating peritoneal inflammation. The late Dr. Wistar once performed the operation with success. In the case of a Mrs. N., a very respectable Jewish lady, I performed a similar operation about fifteen years ago. The tumour, however, was as large as a child's head, and had been strangulated several days before I saw the patient, and, on this account, the operation did not succeed. The patient, too, was advanced in years, extremely corpulent, and had long suffered from derangement of the functions of the stomach and intestines. Under these circumstances, no operation, probably, would have answered the purpose, even if performed in the very commencement of strangulation.

In Lawrence, on ruptures, we find the following:

"The greatest practical writers have strongly represented the frequent fatality of the operation for strangulated exomphalos; and the results of my own experience coincide entirely with their statements. I have, indeed, operated successfully on a large intestinal exomphalos, containing several convolutions of small intestine, of a bright red colour, without any omentum. in a fat woman advanced in years; but the majority of cases, in which I have either operated myself, or seen the operation done by others, have ended fatally.