blage cannot be of equal merit, we shall pay such attention as may appear requisite to each.

A Case of strangulated Hernia, in which a Part of the Abdominal Viscera was protruded into the left Cavity of the Chest. By Mr. Astley Cooper, St. Thomas's Hospital.

This disease was discovered only on the dissection of the patient, but had been indicated during her life, chiefly by pain in the left side, and frequent vomiting, with a sensation of "something dragging to the right side," as she described it. Its real nature was not suspected. The great arch of the colon was pushed into the left cavity of the chest, through an aperture of the diaphragm: a considerable part of the omentum had passed into the same opening; and the intestines were inflamed.

This complaint, the author thinks, may be known in the living subject, by the combination of symptoms of strangulated hernia, with those of an inflammation of the chest; viz. vomiting, costiveness, hiccup, pain and tension of the abdomen, together with cough, oppressed breathing, and an inability to lie on one side, occurring in a person who had been immedi ately before in perfect health. An erect posture, and the warm bath, are recommended for relief.

Some instances of similar morbid appearances are added.

A Case of the Tic Douleureux, or painful Affection of the Face, successfully treated by a Division of the affected Nerve. By John Haighton, M. D.

This case, while it reflects great credit on the sagacity and dexterity of Dr. Haighton, is particularly interesting; as it holds out a prospect of complete relief, in one of those complaints which embitter, though they do not shorten, life. The disease described is fortunately uncommon: but from this very circumstance its nature was less likely to be understood; and it would have been discovered only by an accurate anatomist and physiologist.

The patient, an elderly lady, was subject to repeated and excruciating pains, confined to the ala nasi, and to a small portion of the upper lip, on the right side of the face. The complaint resisted a variety of remedies. At length, Dr. Haighton had an opportunity of observing, during one of the paroxysms, that there was a tremulous motion of the upper lip, just where the musculus levator labii superioris proprius is inserted; and it occurred to him that the sub-orbitar branches of the fifth pair of nerves, which supply those parts, must be the seat of the disease. On the next exacerbation, therefore, he made a strong pressure on the skin over the sub-orbitar foramen, and found

that

that the pain instantly abated. This experiment succeeded repeatedly; and hence Dr. Haighton was led to conclude that the division of those nerves, where they leave the sub-orbitar foramen, might effect a cure.

From a careful comparison of the situation of this foramen, in thirty different skulls, he concluded that at half an inch beneath the lower edge of the orbit of the eye was the proper place for performing the operation; and, from a similar comparison, it was determined that, a line being dra from the inferior part of the internal angular process of the os frontis, obliquely across the orbit to the center of the os male, another line, drawn downward, perpendicular to it, at the distance of 7-8ths of an inch from the internal angle of the eye, passed across the orifice of the sub-orbitar foramen. This cannot be clearly understood without the plate. These preliminary circumstances being settled,' says Dr. Haighton, the operation becomes exceedingly simple, and consists in an incision of 3-4ths of an inch in length, carried obliquely downward *, the center of which must correspond with the foramen, only 1-4th of an inch below it. The incision must be made down to the bone, otherwise we cannot be certain of dividing the nerves, as they are situated very deep. Some other particular directions are given, for which we must refer our readers to this valuable paper. The operation put an end to the pain immediately, and the patient has lived nine years without experienc ing any return.

There was a temporary diminution of sensation and action on that side of the lip, but they were never totally lost, which there was reason to apprehend.

Some observations published in France are mentioned by Dr. Haighton, which he had seen after the performance of this operation; and in which the division of the nerves was proposed as a remedy for the disease:-but his claim to the discovery appears undoubted, since he had been led to it by a process of reasoning entirely unassisted by those publications.

Dr. Fothergill had supposed this disorder to be cancerous; an opinion which is successfully combated by Dr. Haighton, from both theory and practice.

The paper is concluded with some important remarks on similar affections of other nerves of the face, in which the patient cannot be relieved by any operation; and on rheumatic

*Left the reason for giving a slight degree of obliquity to the incision should not immediately strike the reader, it may be proper to remind him of the oblique course which most of these nerves take in their passage from the foramen to the ala nasi.'

pains in the face. We would have gladly extracted these; but, as the whole essay demands particular attention from medical readers, and as our limits would not permit us to insert it entire, we shall content ourselves with declaring that we have been gratified and instructed by it, in an uncommon degree.

Account of a ligamentous Union of the Tibia, after the Removal of a carious Portion of that Bone. By Mr. Richard Smith, Surgeon of the Bristol Infirmary.

In this case, the support afforded by the fibula, which was entire, enabled the patient to make some use of the limb, previously to his death; though a ligamentous substance was formed, instead of a bony callus, to supply the lost part of

the tibia.

Case of a penetrating Wound by a Bayonet passing through the Heart, in which the Patient survived the Accident upwards of nine Hours. Communicated by William Babington, M. D.` by the Permission of John Lind, M. D. Senior Physician to the Royal Hospital at Haslar.

This patient fell on his own bayonet, in consequence of slipping from the deck of a ship, and did not feel himself much wounded at the moment. He drew out the bayonet himself, walked several steps, and then fainted. His body became cold, and his pulse scarcely perceptible. No blood flowed on opening a vein. All liquids received into his stomach produced sickness and retching, but no actual vomiting. He felt a suffocating weight on the right side of the breast; and a sudden strangulation in the throat carried him off.-The bayonet was found, on dissection, to have passed obliquely upward, from the left side of the abdomen, and to have penetrated the right ventricle of the heart, and through both the upper and middle lobes of the lungs.

Instances of this kind, though they afford no practical inferences, are worthy of record, as they tend to render our ideas more correct concerning the effect of injuries of the vital parts. Wounds of the heart have been generally supposed to prove immediately fatal. There are some facts, which seem to shew that wounds inflicted by the bayonet are less dangerous than might be expected: but, in the present case, the number of important organs perforated by the weapon was very great.

An Account of a Rupture of the Aorta near the Heart. By Mr. Lynn, jun. Surgeon, at Woodbridge.

The rupture of the aorta took place, in this patient, during the pains of labour; and the singularity of the case consists in her having survived the accident from the 11th to the 25th of the

month.

month. The author ascribes the rupture to debility in the aorta, occasioned by chronic inflammation.

On the Use of the Tinctura Ferri Muriati, in those Suppressions of Urine which arise from a spasmodic Affection of the Urethra.

Under this head, we are presented with an extract from Mr. Cline's Lectures, containing an account of a retention of urine from a spasmodic stricture of the urethra, which was relieved by a tobacco-clyster: but it caused so much faintness, cold sweat, and disagreeable feeling to the patient, that, on a return of the complaint, he would not consent to a repetition of the remedy. Mr. Cline then gave him ten drops of the tinctura ferri muriati every ten minutes, till it should produce some sensible effect. When he had taken six doses, his urine flowed freely. The same medicine relieved him on several relapses.

Retentions of urine from other causes, we are told, are not affected by this remedy.

Three Instances of Obstruction of the Thoracic Duct; with some Experiments, shewing the Effects of tying that Vessel. By Mr. Astley Cooper.

These curious facts promise a considerable addition to our knowlege of the diseases of the lymphatic system. They shew that the thoracic duct is liable to scrophulous inflammation, and to consequent ulceration and obstruction; and they discover the provision made by nature to prevent the suspension of the functions of this important organ, in the existence of anastomosing lymphatics, which convey the chyle circuitously to the upper part of the duct, in case of its obstruction in the trunk. The pathology of the absorbents is almost an untouched subject; perhaps these and some other facts will induce physiologists to consider this class of vessels as more analogous to those which circulate red blood, than they have hitherto been disposed to allow.

The experiments on tying the thoracic duct, in dogs, seem, in Mr. Cooper's opinion, to be unfavourable to the doctrine of the retrograde motion of the absorbents; for he found, on dissecting the animals on which the experiments had been made, that many of the lacteals were extremely distended with chyle, and that some of them were actually ruptured.

We hope that Mr. Cooper will prosecute this important inquiry; and that he will continue to make additions to our know. lege of a class of diseases hitherto concealed from view, but which ought perhaps to come frequently within the calcula

tion of the practitioner, in deciding on the conclusions to be drawn from internal symptoms.

Two Cases of Rabies Canina, in which opium was given, without success, in unusually large quantities. The one by William Babington, M. D. the other by William Wavell, M. D.

Nothing occurs either in the history or the dissections of these unfortunate victims to this terrible disorder, which can serve to direct practitioners in their future conduct respecting it.

A Case of the Casarean Operation performed, and the Life of the Woman preserved, by James Barlow, Surgeon, late of Choricy, Lancashire, but now of Blackburn in the same county.

A successful case of the Cæsarean operation is so rare an occurrence, that it naturally excites considerable attention. The operation has been so uniformly fatal to the mother, in this country at least, that we perused Mr. Barlow's narrative with considerable eagerness, to, learn the minuter circumstances of so extraordinary an event. We must confess, however, that his own relation of the fact, added to the doubts started in a late publication on this subject*, have led us to question whether this were really a case of the Cæsarean operation. In describing the steps of the performance, Mr. Barlow tells us that the uterus was very thin, scarcely exceeding that of [the thickness of] the peritoneum, and equally so through the whole extent of the incision.' It is surely impossible that the pregnant uterus could be so thin, at the full period of gestation. Did not Mr. Barlow mistake the membranes for the uterus? And had not the foetus escaped, at some period of pregnancy, into the cavity of the abdomen?

If the child had passed through a laceration of the uterus into the cavity, whether long or soon before the operation, the danger attending the extraction would evidently be much diminished; at least, as far as respects the process of the opeIt would become a mere case of gastrotomy.

rator.

A singular Case in Lithotomy. By R. B. Cheston, M. D. This case can scarcely be understood, without seeing the whole of the paper. A stone so firmly fixed in the neck of the bladder, projecting into the perineum, that it could not be extracted by any of the usual methods, was cut upon through the urethra, and the wound was kept open for five weeks; at

* Dr. Hull's Defence of the Cæsarean Operation. See M. R. for May last.

REV. JUNE. 1799.