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more attentively examining the pathological phenomena in scirrhous and cancerous tumours were afforded me. The following was the result of these investigations. In the circumferential part of the tumour I found all the usual phenomena of pure inflammation; nearer the centre there was simple white induration; still nearer, this white induration was observed to have passed into the state of scirrhus; and in the centre itself was the genuine cancerous degeneration. Now then, the judicious employment of leeches and other antiphlogistic remedies may succeed in removing all the circumferential morbid changes, although we cannot hope that they will dissipate, or even arrest, the central degeneration. This, however, is an important end gained; for in this manner we may reduce the size of the swelling to one half of its former size, and thus render the operation, which is necessary, less formidable and severe independently of the surrounding parts being at the same time brought into a state which is more healthy and more disposed to speedy union and cicatrisation. I again repeat, however, that we must not expect. in any case, to get rid of the central or genuine cancerous tumor by the use of antiphlogistic or of any other local means; and I have seen much mischief follow from an unwisely prolonged attempt to effect this."

In a patient, whom M. L. recently saw, the swelling of the mamma had been reduced by at least two thirds, and then it became and remained stationary; nevertheless, she was recommended by her medical attendants to persevere with the use of leeches, &c. For a month no additional progress had been made; and therefore M. Lisfranc, who was now called in, advised the immediate extirpation of the tumor. Unfortunately the lady was induced, by the suggestion of some friends, to defer submitting to it for several weeks; a cancerous explosion took place, several new ulcerated points formed, and the patient died.

As a general rule, M. Lisfranc recommends that the operation should not be delayed, whenever there has been no visible amendment of the swelling for three or four weeks past. If such be the case, it is not only a fruitless annoyance of the patient to continue the use of leeches and other antiphlogistic remedies, but the cancerous disease may thereby be permitted to make serious progress, and thus render the removal of the tumor more difficult and severe.-La Langette Française.

ON THE INFLUENCE OF SPLENIC ENGORGEMENTS ON AGUES.

It is quite unnecessary to do more than simply allude to the very great frequency of congestion and enlargement of the spleen after attacks of intermittent fever. The important question is, what is the effect of such a state on the health of the patient? and how is it best remedied?

M. Bally was the first to shew distinctly that the marked tendency to the relapse of intermittent fevers, after they have been seemingly got rid of, is mainly attributable to the engorgement of the spleen which is permitted to remain. The fever may have quite ceased to return for one or even several months, but the patient, notwithstanding, does not recover his former health and strength; his complexion remains pale, his appetite is variable, his digestion is not good, and his muscular energy remains feeble; and at length the periodical feverish symptoms begin again to make their appearance.

In a recent lecture at the Hôpital de la Charité, M. Nonat has inculcated the opinions of his predecessor with much ability.

"We will not affirm," says he, "that hypertrophy of the spleen produces intermittent fever; this has its point de depart in some unknown cause, whether of the nature of miasm or otherwise, and inappreciable in its nature; but certainly it cannot be denied that such hypertrophe is an occasional and predisposing cause, which keeps the system under the influence of this primitive agent."

By far the most potent agent in subduing this enlarged state of the spleen is the Peruvian bark. But this must be given in larger doses than is usually done. It is more than probable than the frequency of the relapse of agues is mainly at-. tributable to the insufficient administration of this most valuable specific. Such was the opinion of Morton, Sydenham and Torti ; and the experience of the best practitioners in the present day confirms its truth.

M. Nonat remarks: "M. Bally was the first in France who distinctly pointed out the efficacy of quinine in the treatment of intermittent fevers, and more especially in those cases which are accompanied with considerable engorgement of the spleen. According to this experienced practitioner, we should commence with eight or ten grains of the salt every eight hours, and raise the dose quickly if the case be obstinate, to 40 or even 60 grains in the course of the day. I have seen M. Bally obtain, by this method, a success which it is vain to expect from the same remedy when administered in the usual manner."

M. Piorry assures us that under the use of large doses of quinine-from 40 to 80 grains in the course of twenty-four hours-he has seen considerable engorgements of the spleen subside in a few days.*

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M. Nonat has investigated this subject of practical medicine with much zeal ; and the conclusion at which he has arrived is, that the quantity of quinine required to effect a permanent cure of an ague, and of the induced enlargement of the spleen, is almost always in a direct ratio with the amount or extent of this enlargement. After a great many experiments," he says, "I have satisfied myself that the dose of quinine should vary from 12 to 40 or 50 grains in the course of twenty-four hours, and that it must be proportioned to the increase in the size of the spleen; such are the doses which we have been in the habit, for the last three years, of using with such marked success. Hitherto we have met with very few cases indeed of enlargement of the spleen, which have resisted this method of employing the quinine."

The length of time, during which it may be necessary to continue the use of the remedy, varies much according to several circumstances, such as the extent of the enlargement, the duration of the complaint, the constitution of the patient, and so forth. But, whatever be the case, its employment should not be discontinued until the viscus has resumed its normal dimensions. In some cases, the stomach will not bear the large doses that are required; we must then administer the quinine in enemata, and in still greater quantities. To derive success from this mode of treatment, it is quite necessary that the enemata be retained; else all the febrifuge effects of the quinine will not be obtained. "When this condition is fulfilled," says M. Nonat, "I have in every case observed that the fever ceased, and the engorgement of the spleen subsided, as quickly as when the quinine had been administered by the mouth; and this too in patients affected with most obstinate agues which had resisted the ordinary plan of treatment in various hospitals."

M. Nonat does not expect much from the endermic use of quinine, as recommended by some physicians; the fever may indeed be cured, but not the splenic disease, in this way. He has tried in a few instances the iatroleptic method, or that of rubbing the quinine in, in the form of an ointment. Forty or fifty grains of the salt were mixed with two ounces of lard, and the patient was directed to rub in some of this ointment on the groins and armpits three times a day. Under this mode of treatment, the fever has been known to cease, and

Dr. Elliotson, in some of his clinical lectures reported in the Lancet five or six years ago, very forcibly inculcated the same views as to the treatment of the enlargement of the spleen, which so frequently follow intermittent fevers." -Rev.

the splenic enlargement to subside a little; but never to any considerable extent, or permanently.

Before closing these remarks, we should mention that, in most cases of ague attended with enlargement of the spleen, the local abstraction of blood, by cupping or leeches, from the left hypochondrium will greatly promote the efficacy of the quinine.-La Langelte Française.

M. CAZENAVE ON SCABIES.

The following extracts are from a lecture which M. Cazenave recently delivered at the hospital St. Louis, to which, it is well known, by far the greater number of patients affected with cutaneous diseases in Paris are sent.

"With respect to the seat of, or the parts of the body most frequently affected with, the itch, it is right to observe that certain conditions and occupations of life, under the influence of which the disease is apt to be developed, induce varieties which deserve to be noticed. Thus in smiths and dyers we rarely observe the scabious eruption on the wrists or between the fingers; whereas these are just the parts which are almost always affected in tailors and semstresses-who constitute a large proportion of itch-patients admitted into the Hospital St. Louis. M. Cazenave has never seen the face affected with the disease."

"When the disease is left to itself, more especially in young plethoric persons, it is apt to become complicated with other forms of cutaneous eruption-most frequently of the impetiginous or ecthymatous character. It is from not being aware of this complication, that some writers have described scabies as a pustular disease."

"It is now universally admitted that the proximate cause of the itch is the presence of an animalcule—the acarus scabiei. It is well known how frequently the truth of this idea has been questioned. The cause of the difficulty of detecting the insect was first explained by M. Renucci in 1834, who shewed that it is seldom found in the vesicle itself, but generally in the groove of the skin leading from it, and which the insect itself makes under the epidermis."

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Diagnosis.-Every medical man knows well the occasional difficulty in determining whether certain cutaneous eruptions are truly scabious or not. This is the more annoying, as the appropriate treatment depends on the correct diagnosis of the disease; an error in this respect may be followed by the most troublesome consequences. Scabies may be confounded with some of the forms of eczema. In the latter disease, the vesicles, even when they are situated in the fingers and on the inside of the arms, are flattened on their summits, and not pointed as in the vesicles of genuine scabies; likewise, they are more congregated together, they appear on the back of the hand as well as along the line of the flexure of the joints; the pruritus too accompanying eczema is more of a burning or scalding character, and not subject to those exacerbations so characteristic of the genuine itch.

Herpes appears in patches, and can scarcely be confounded with scabies. Prurigo is not so readily distinguished. Apart however from the primitive characters of the eruption, it in most cases affects chiefly the back, shoulders, and the limbs, rather along the line of extension, than along that of flexion.

The pappulæ exhibit at their apices a blackish crust: and the itching, though troublesome, is never comparable to that of genuine scabies.

But we must acknowledge that in some cases, it is impossible to discriminate with confidence the exact nature of the eruption."

"It is not unfrequent to observe in persons, who have been

affected with scabies, a vesicular eruption returning every year, especially during warm weather. This affection is not strictly scabious, nor is it contagious. It does not therefore require the specific treatment necessary in itch; and very generally it will disappear under the local application of cooling washes."

"Treatment.-The ointment generally used by M. Biett is one of the best. It consists of two parts of sulphur, one of subcarbonate of potash, and eight of lard. The lotion of Dupuytren-composed of four ounces of sulphurate of potash, a pound and a half of water, and half an ounce of sulphuric acid-will often succeed where the patient is unwilling to rub in the sulphur ointment. It has however the twofold disadvantage of being very irritating, and very offensive to the smell.

One or two brisk doses of a cooling purgative will always be useful. No other internal medication is necessary."--La Langette Française.

ON CONVULSIONS DURING PREGNANCY AND DELIVERY.

The following general conclusions close a very able memoir on the above subject from the pen of one of the most experienced accoucheurs in Paris, M. Capuron.

1. Convulsions occur much more frequently during a delivery at the full period than during a miscarriage-doubtless, from the greater severity of the pains and the consequent greater disturbance of the circulatory and nervous systems. Indeed it is truly astonishing that such protracted suffering as almost ́ always accompanies a first labor does not in every instance induce some convulsive attack.

2. The majority of the women, who are seized with convulsions during pregnancy or labor, are of a sanguineous and plethoric constitution, and usually of an irritable and highly nervous temperament.

3. The attack is often preceded by some precursory symptoms, such as headache, confusion, noises in the ears, twitches of the tendons of the fingers or toes, or of the muscles of the face, and a tendency to bewilderment and forgetfulness. The patient is usually much depressed in her spirits, and very apprehensive of the result of her labor.

Perhaps, however, generally the convulsions come on unexpectedly and without any premonitions.

4. The convulsions, after lasting for a longer or shorter period of time, usually terminate in deep somnolence, during which the respiration is heavy and more or less stertorous, and the pulse is full and large, such as is commonly felt in sanguineous apoplexy; occasionally a partial tetanic contraction of the jaws continues for a considerable time after the abatement of the general spasms.

5. From what I have observed, I am inclined to be of opinion that an attack of convulsions during a premature labor is on the whole more dangerous than a similar attack if the labor should be at the full period of gestation.

We might expect that this should be the case, when we consider that the cervix uteri is generally harder, less pliant, and more resisting, if labor happens to come on in the seventh or eighth month of pregnancy.

6. According to the results of my experience, local and general blood-letting and the use of warm relaxing baths are the most powerful means both to prevent and to arrest the attacks of puerperal convulsions. The blood-letting relieves the congested vessels of the head, and probably also the sanguineous accumulation in the uterus, and the warm bath takes off the spasmodic state of this organ and of every other part of the body, by inducing a derivative action towards the surface. As auxiliary means of occasional utility, the extract of

belladonna rubbed on the cervix uteri, and some of the milder preparations of opium given internally, may be mentioned with praise.*

7. If we should find on examination that the cervix uteri forms a rigid band around the head or neck of the child, and that the labor-pains make little or no impression upon it, even after blood-letting and other relaxing means have been used, we should not hesitate to divide the constricting portion at one or two places of its circumference with a bistoury. In all such cases, it becomes the accoucheur to ascertain the state of the urinary bladder; as it has been found, in more than one instance, that over-distention of this viscus has powerfully predisposed to, if it has not actually caused, the occurrence of convulsions during accouchement.

If the head of the child be within reach of the forceps, we should never hesitate at once to finish the labor by extraction. But if this be impracticable, and the convulsions still continue, recourse must be had without delay to the use of the perforator and crotchet.-L'Experience.

CHILBLAINS TREATED WITH MUSTARD BATHS.

Mustard powder enters into the composition of several ointments which, at different times, have been strongly recommended in the treatment of chilblains; it is contained in the pommade of Swediaur, which has been so long known and esteemed.

A writer in the Journal des Connoissances Medicales alludes to the good effects of mustard baths in the following terms:

"A friend of mine suffered so much from chilblains, that he could scarcely walk across his room. As he was afflicted with severe headaches at the same time, I advised him to use a sinapised foot-bath for two or three nights. Finding himself much relieved both in head and feet, he continued their use for nearly three weeks. This was in the month of November. He had no return of his chilblains during the whole of the winter; and in the following year, by having recourse to the baths, he again remained entirely free from his old most troublesome complaint."

Remark. A very good application to that most vexatious malady, a chilblain, is the diluted tincture of iodine. The effects of this remedy resemble, in many respects, those of a solution of nitrate of silver; both having a very marked, and often a singularly beneficial, influence on cutaneous complaints, especially when these are connected with a chronic or subacute inflammation of the part. have recently used the iodine tincture with good effects in some forms of porrigo.-(Rev.)

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MEMORANDA ON CUTANEOUS TRANSPLANTATIONS.

"When erysipelas comes on in the face after a rhino-plastic

* M. Capuron omits to mention two of the most powerful remedies in the subjugation of puerperal convulsions-viz. the tartrate of antimony, and full doses of camphor. The former may be given in doses of half or of a whole grain, combined with a drachm of syrup of poppies, every quarter of an hour, (after venesection) until the spasm relaxes. From five to ten grains of camphor with fifteen to twenty drops of tincture of henbane, administered every half hour or so, constitute also a most potent remedy.-(Rev.)

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