with goitre, protruded eyeball, and symptoms of cardiac derangement, has called forth five illustrative cases from Mr Cooper. Dr Alison's observations also tend to confirm Dr Begbie's views, inasmuch as in two of his five cases of goitre, anæmia existed in marked degree]. Of Mr Cooper's five cases, four were females, and Dr Alison's four cases of goitre were all females. In three of the former series of cases, there had existed derangement of the catamenia, but this consisted in a scanty or altogether suppressed discharge, and not, as in some of the earlier cases described, in an increased flow. No allusion is made in Mr Cooper's cases to any previously existing cause, sufficient to account for the first occurrence of the anæmia. In Dr Begbie's cases menorrhagia and wasting hemorrhage from piles, evidently operated as the exciting causes. With this exception, the cases of Mr Cooper are identical with those of Dr Begbie; the same train of symptoms are manifested, and all appear easily referable to the same pathological condition.

A different explanation, however, has been offered by Mr Cooper in regard to the phenomena presented by the eyeballs. He considers it a simple protrusion, and not a dropsical enlargement, and mentions an explanation of the manner in which this protrusion is caused, as suggested by Mr Dalrymple; the latter believes it to be owing to the operation of two causes, an absence of the proper tonicity of the muscles by which the eyes are retained in their natural position in the orbits, and some amount of venous congestion of the tissues forming the cushion behind the globes.

[This explanation, whether applying or not to Mr Cooper's cases, is, in those recorded by Dr Begbie, inadmissible. That in Dr Begbie's cases true hydrophthalmia existed, there is the testimony of Mr Walker,

a most experienced oculist, and both he and Dr Begbie affirm that a positive enlargement of the eyeballs existed. Dr Begbie mentions, that vision was not much affected, and the same remark was made by Dr M'Donnell when recording his cases; but though impaired vision is generally considered as a sign or symptom accompanying hydrophthalmia, the exact cause upon which the aqueous effusion depends, will doubtless materially affect the degree in which this symptom exists.]

The treatment of his cases Mr Cooper has conducted with reference to the anamic condition of the system on which he believes these special symptoms to depend. The most efficacious remedies are iron, aloes, and myrrh, with sedatives, ablution of the body with cold salt and water, followed by friction, and if there be any indications of hysteria, friction along the spine with a stimulating liniment. The application of cold water to the eyes is recommended.

Dr Alison believes goitre to be a local disease, though its rise and progress is favoured by certain general morbid conditions of the system; these general conditions being debility and anæmia. Of treatment Dr Alison speaks of local and constitutional; under the former he recommends pressure, the application of various forms of plasters, of iodine of mercury or ammoniacum, or a combination of these. Under the head of constitutional treatment, when the goitre has been associated with anæmia, the author has prescribed iron, generally the iodide, the valerianate when hysterical symptoms have been prominent. After a time, chalybeates and the mineral acids have been found beneficial. Careful attention to the regimen known to be useful in such cases is enjoined.-Lancet, No. 21, vol. i. 1849. London Journal of Medicine, No. 6.

243.-Treatment for the Cure of Hernia in Infants. M. BAYARD, of Cirey (Haute Marne), after having stated the frequency of umbilical hernia in new born infants, and pointed out the difficulties of keeping the hernia reduced by means of the ordinary bandages, advises the use of the following apparatus :-He takes an oblong piece of cere-cloth, about three fingers' breadth, and twice as long; if it is not sufficiently adhesive, he spreads it over with diachylon. He next takes a small piece of very fine and pliable sponge, nearly as thick as half an almond, and having

given it the form of a truncated cone, he fixes its base to the centre of the cerecloth by means of the diachylon. Then reducing the hernia by the index finger of the left hand, and having warmed the dressing with the right, he applies it quickly, by placing the summit of the cone of sponge on the reduced hernia, and then passing the hand pretty strongly along the cere-cloth, keeping up this light pressure for about a minute to allow the diachylon to attach itself closely. This slight dressing remains, in situ, without the aid of compress or bandage, and without any

fear of being deranged by the necessary attention to cleanliness and the other wants of the infant. Its action is to keep the hernia reduced by means of the slight elasticity of the sponge constantly causing a spring. M. B. has never seen the diachylon do any injury to the skin. [Although this means has produced good effects in M. B.'s hands, it is not to be doubted, that the diachylon, although preferable to ordinary bandages, must be very liable to be detached from the skin, either by the movements of the young patient, but more especially from the perspiration which takes place beneath the plaster, if this perspiration be at all abundant. Perhaps this may lead to the trial of, and in case of success, may bring into use, under these circumstances, the adhesive properties of collodion, which he appears not to have thought of.]-Gazette des Hôpitaux, 6 February 1849.

244.- Unusual Dislocation at the Shoulder Joint. M. MALGAIGNE relates a case of unusual dislocation at the shoulder :François Chauche, 63 years of age, a daylabourer, was admitted into the Hospital of St Louis on the 31st of October 1848. On the 15th August he was thrown from a cart to a great distance, and fell on the tip of his right shoulder; he states that his arm was pressed against his body, but cannot say whether it was carried forwards or backwards. Feeling great pain, and being unable to move his arm, he went to a bone-setter, who applied violent traction, and sent him away with his arm in a sling, saying it was cured. He kept on the bandage eight days, and then tried to move his arm, but in vain, each attempt causing great pain. The pain lessened by degrees, and he could move the arm slightly, but the motion was so confined, that he determined, after two months and a-half, to come to the hospital. The shoulder presented a singular deformity. It was flattened as in ordinary luxations, the finger could be passed into a depression immediately below the acromion, and the glenoid cavity was evidently empty. Moreover, the two corresponding edges of the acromion, as also its anterior angle, could be easily felt; in front of this angle, almost beneath the clavicle, there could be seen and felt a large, hard, and spherical projection, continuous with the shaft of the humerus, obeying all the movements given to that bone, and which evidently was the head of the humerus. On its external surface was the anterior or internal surface of the acromion; on its superior, the inferior surface of the clavicle, and it almost completely filled up the space between these two parts. The

M.

projection was so great, that it extended for two inches beyond the anterior surface of the clavicle; and it was so superficial, that at some parts it seemed subcutaneous; at the most prominent part the thickness of the integument and muscles was only one-third of an inch, and a little further inwards only a quarter of an inch. Malgaigne's opinion was, that the head of the bone had at this spot separated the deltoid and great pectoral so as to become almost subcutaneous. To satisfy himself, he ordered the patient, while the elbow was pressed against the body, to endeavour to remove his arm, and, accordingly, he felt the borders of the two muscles contract and leave an interval between them of less than an inch where the head of the bone was only covered by skin. It was evident, then, that the head of the humerus had been carried forwards and upwards above the coraco-acromial ligament and coracoid process; this process could not be felt, the head of the bone completely covering it. On the uninjured side it was deeply situated, somewhat more than an inch behind the level of the clavicle. The following measurements are given by M. Malgaigne (the centimetre is nearly two-fifths of an English inch):—The clavicle was 17 centimetres long, the most internal part of the dislocated head was 9 centimetres from the sterno-clavicular, and 8 from the acromial articulation. On the left side the clavicle measured a little more than 13 centimetres (?) It was necessary also to examine the disposition of the neighbouring parts. At first sight the arm appeared to be shortened, and, in fact, the head was seen projecting above the top of the acromion. However, by measuring the arm, and also the anterior pa. rietes of the armpit, there was found to be only half a centimetre of shortening. The armpit was quite empty and free, so high that the whole finger could be passed into it. The elbow was not very much drawn out from the body, and a ribbon stretched from the posterior angle of the acromion to the epicondyle was not drawn out from the insertion of the deltoid even a centimetre; while, on the sound side, it was more than one. There was no abnormal rotation. The condyles of the humerus had the same relations as on the sound side, and so also had the shoulderblade. Revue Medico-Chirurgicale de Paris, Jan. 1849.

sex, are well developed, nevertheless their bodies are rather small in size; the four arms and legs are equally developed respectively. There is no concord of the functions; each has a separate life; so that often the one sleeps while the other is crying and weeping, or the one eats and takes the breast while the other continues sleeping.

So also the act of defecation does not occur simultaneously in both. Syrup of violets given to the one provokes evacuations of a deep green colour; while the stools of the other are devoid of this coloration, and vice versa,—a fact which sufficiently demonstrates that each of them has a distinct digestive apparatus.

The parents are of good constitution, and belong to the class of day labourers. The father's age is 44 years, the mother's 38; they have previously had three children, whereof one is still living. The mother states herself to have experienced nothing at all remarkable during preg

nancy.

The labour lasted a long time, and the expulsive pains were very severe. The child on the right was the first to be expelled, the head presenting: the other followed five minutes after; but, according to the midwife's statement, its feet came first. There was but one navel string and after-birth.

These truly curious beings, whom we propose to designate " The Flemish Twins," have received names, the eldest that of Marie, the youngest Sophia. They continue to enjoy good health, and every. thing promises that they will continue to live.

The question has been proposed to me as to whether it would be possible to separate them by an operation; but the results furnished by palpation and percussion of the seat of junction, give a strong presumption of a communication between the two abdominal cavities, and have thus dictated to me an answer in the negative. -Med. Times, 4th July 1849.

;247.-On Neuralgia of the Cervix Uteri. By M. MALGAIGNE.-M. Malgaigne believes this to be by no means the rare disease it is generally thought to be. There are, indeed, two forms of neuralgia of the female genital organs-neuralgia of the cervix, and neuralgia of the appendices. Neuralgia of the cervix is often combined with leucorrhoea, or with an engorged state of the neck or body of the uterus. Its essential characteristic is the presence of a painful point, generally a solitary one, and almost always seated anteriorly, and towards the left. It is very rare for this

tender spot to exist without being accompanied by neuralgic pains in the abdomen, loins, epigastrium, &c. These painful irradiations vary, both as regards their seat and extent, and are very likely to be mistaken for other affections. In several cases mere repose gives great relief; but in obstinate cases the greatest variety of means are sometimes unavailingly tried. M. Malgaigne, calling to mind, that in other neuralgia, the causes of which he could not discover, he had by their obstinacy been driven in despair to divide the affected nerve, resolved to proceed in an analogous manner in this case, and the incision of the painful point of the cervix was attended with great success. He has now performed the operation several times, and in but two instances has hemorrhage occurred, in both of which the curved scissors had made the incision horizontally. The vertical section has been attended with the loss of only a few drops of blood.-Rev. Méd.-Chir., iv. 333-40, and Med.-Chir. Rev., July 1849.

248.-Intra-vaginal Respiration recom mended in some cases of Parturition where the Child's Life is in Danger from Pressure on the Cord. By M. M'CULLOCH, M.D.

The writer desires to make known a new mode of practice, by which he thinks that the amount of infant mortality will be lessened in many cases in which death, from pressure on the cord, is otherwise inevitable. "If we take the average of French, German, and British practice, we find by the most authentic statistics that danger to the life of the child from this cause occurs in breech presentations once in 53 labours; in presentations of the superior extremities, after turning, once in 261; and where the cord presents, once in 245 cases. Thus we have in 649 labours 12 presentations of the breech, 7 of the inferior extremities, 24 of the superior extremities, and 2 of the cord, occasioning a loss of life at birth of about two per cent. of all children born. This great mortality I think I have succeeded in diminishing in my own practice in three footling cases within the last eight months, by enabling the child to breathe while the head was still within the cavity of the pelvis, after the pulsation in the cord had been several minutes extinct. And this novel state of existence was maintained by keeping the child's mouth open with my finger, and the perineum expanded to allow air to have free access into the vagina. In future, I shall endeavour to accomplish this object with greater certainty by introducing into the mouth the end of the largest-sized gum-elastic male catheter,

with several perforations in it, and continue as before to allow as much air as possible to approach the face and nostrils. In all cases of malposition in which the practice I have suggested becomes desirable, the chance of respiration being established will be greater, if the means are used before the circulation becomes feeble in the umbilical vessels; and if the child is born alive in the absence of pulsation in them, it may fairly be conceded that we have been successful in our efforts to preserve life. Some cases may occur where a small-sized male catheter, with a suitable curve, might be used with advan

tage as a tracheal pipe. I need scarcely add that the infant's body should be kept warm, gentle traction employed, and all the other ordinary means of exciting contraction of the uterus used until the delivery is completed.

"If the practice I have here recommended is found to answer in other hands as it has in my own, something will have been achieved in obstetric science, in circumstances where the most skilful have hitherto frequently had to lament their inability to save the child's life."-British American Journal, May 1849, and Med. Chir. Rev., July 1849.

249.-Lemon Juice in Rheumatic Diseases. By Dr G. O. REES.-Dr Rees directed attention, some time ago, to the beneficial effects of lemon juice in acute rheumatism, and he has more recently put forth, in the form of a pamphlet, the details of eight cases of this disease, successfully submitted to the new treatment. He considers the lemon juice superior to colchicum in its power of affording early relief to pain, subduing fever, and shortening the duration of the disease, and the cases recorded, so far as they go, undoubtedly warrant this statement. But, with a disease so capricious in its nature as acute rheumatism, a very extended experience is necessary to arrive at a correct estimate of the value of any new method of treatment. It so often happens that a number of severe cases, occurring consecutively, get well with unusual rapidity under all kinds of treatment, that we are led to attribute the recoveries to some accidental peculiarity in the nature of the disease itself, and not to the treatment employed.

The form of rheumatic disease in which the greatest benefit would appear to have been derived from the use of lemon juice, is acute rheumatism; and that form of rheumatic affection involving the smaller as well as the larger joints in acute inflammation, known as rheumatic gout.

In cases of pure gout, in which the inflammation is high, it is said that great advantage has been obtained, while in sub-acute and more chronic forms of the disease, the same marked benefit has not been experienced. Nor is it found in acute rheumatism that benefit accrues from continuing the remedy when the inflammatory symptoms have been checked, and debility remains.

In doses of half an ounce to an ounce

thrice daily, the lemon juice appears to exert a marked sedative effect on the circulation; in one case, the pulse, which was 120, and full, was after one day's treatment reduced to 75, and rendered at the same time smaller; in another case, the pulse, which was 110 when the lemon juice was first given, was in two days reduced to 100, and in four days to 74. If we can rely on results obtained in one experiment, this action is manifested also in the healthy body. A clinical clerk took one ounce of the juice three times a day for three days, and carefully noted his pulse, which was naturally full, and 75 in the minute. After five doses the pulse became much weaker and more compressible, and numbered 70 in the minute; conditions accompanied by a feeling of general depression. On the third day the pulse became as low as 66, and was very small and compressible. The urine was always acid, and also natural in quantity till the third day, when it increased somewhat; the specific gravity was then 1017, and there was a deficiency of lithic acid.

In the cases of rheumatism related by Dr Rees, the urine was never rendered alkaline by the use of the lemon juice, and in one case, in which the urine was alkaline before treatment, it became acid after the juice had been employed. We think it premature to speculate on the modus operandi of the drug, until its utility shall have been confirmed by more extended experience, and before we are in possession of more accurate knowledge as to its physiological action, more especially in reference to its effects on the urine, and the quantity of solids contained in that secretion.-The Treatment of Rheumatic Diseases by Lemon Juice, with Cases. By G. O. Rees, M.D., F.R.S. London, 1849.