the case was the occurrence of such extensive laceration of the lung without rupture of the pleura, or fracture of the ribs. These parts were examined with great care, but no solution of continuity could be discovered. The effused air had first passed into the mediastinum, and subsequently into the cellular tissue of the neck and trunk. This was the fourth case of rupture of the lung, without fracture of the rib, which Mr. Smith had witnessed. The first case was that of a woman who had met with a severe accident, and in whom this condition was discovered after death. The next case was that of a dog which was killed near the Richmond Hospital, by a ear passing over its body. Mr. Smith examined the body shortly after the accident, and found that, although there was not a single rib fractured, the pericardium was torn in various directions, and the lung extensively lacerated. The last case was that of a man brought into Jervisstreet Hospital, who had general emphysema and rupture of the lung, without any injury of the ribs or pleura. 3. Softening of both Lobes of the Cerebellum-Symptoms. Our readers are aware of the uncertainty that obtains in reference to the functions of the cerebellum. It is thought to be a regulator of motion, and to be connected with the venereal passion. The following facts do not seem to lend much confirmation to either notion. The subject of the case was a young woman, æt. 26, unmarried, and who enjoyed perfect health until three months before her death, when she was attacked with intense headache, not referred to any particular part of the head, and accompanied by sickness of the stomach in the morning. When she applied at St. Vincent's Hospital, she was almost completely amaurotic, and had double vision, which continued until her death; her headache was intense, but intermitting; she suffered greatly from globus hystericus. Previous to her admission into the hospital, she had undergone a course of mercury and while in hospital, she was again salivated with temporary benefit; under the use of mercury her pulse fell from about 90 to 72; and for some time her febrile symp toms underwent a marked improvement. She had no paralysis during the whole course of the disease; the prominent symptoms were intense, but not constant headache, globus hystericus, double vision, amaurosis, and strabismus. She died rather suddenly about three months after the first appearance of her symptoms. Upon examination after death, the anatomical characters of chronic inflammation of the membranes of the brain were found, and both lobes of the cerebellum were softened nearly throughout their whole extent, and of a pale rose colour. 4. Flaccid state of the Heart in Fever.-Dr. Stokes has observed that in certain cases of typhus, the sounds of the heart are greatly diminished, so that one or both become more or less indistinct. In such cases, he has stated that there is a specific change, or softening of the heart's substance. Dr. Graves exhibited the heart of a man labouring under typhus without macula. He was admitted into the Meath Hospital on the fourteenth day of his illness. It would be unnecessary to give any detail of the symptoms, further than to state, that on admission his pulse was strong and dicrotous, continued so for some days, and did not lose this character until five or six days before death. He died on the thirty-third day of fever. During the course of the disease, the chief symptoms were a dry tongue, dicrotous pulse, general bronchitis, with congestion of the lung, and diarrhea. Some thought that one of the sounds of the heart was inaudible; but this was dubious. The man died on the thirty-third day of the fever. There was a general flaccidity of the heart, but no evident specific softening of its substance. 5. Co-existence of Scirrhus of the Pylorus and Tubercles of the Lungs.—Mr. Smith presented the recent parts in this case, one of the lungs contained a tubercular cavity, which had evidently existed for a considerable time, and several scattered groups of tubercles were found in both lungs. Along the lesser curvature of the stomach, and completely encircling the pylorus, there was a large cancerous ulcer, the surface and circumference of which presented numerous fungous growths, the mesenteric glands were much enlarged, and filled with a white, cheesy matter, of a scrofulous character. Similar cases have been mentioned by Bayle. - 9. Is Bright's Kidney the cause of Albuminous Urine ?-Dr. Graves exhibited a case of granular kidney, and detailed the particulars of the case. The Reporter states: A question then arose, whether that state of the kidney termed Bright's kidney" was the cause of albuminous urine, or whether it was to be looked upon in an opposite point of view, and regarded as the consequence. Dr. Graves said he was inclined to adopt the latter opinion for various reasons. He had seen so many persons cured of albuminous urine under various circumstances, that he should hesitate in ascribing this condition to a permanently disorganized state of the kidneys. A remarkable instance of this occurred in the person of Staff Surgeon Finnie, Surgeon to the Military School at the Park; about six months ago he was attacked with pleuro-pneumonia of the left lung, of a very severe character, and speedily followed by anasarca. About the time the anasarca was making its appearance, his urine became highly albuminous, and continued so for nearly six weeks About the time when the pectoral symptoms were about to yield to treatment, the anasarca and ascites began to disappear, and at the same time the urine began to lose its albuminous character. In this case the pectoral symptoms were so severe, that for some time Dr. Graves indulged but faint hopes of his recovery. The antiphlogistic treatment pushed to its furthest extent, mercury to salivation, and repeated and powerful vesication succeeded in removing the disease, and with it all trace of albumen in the urine. The case occurred about six months ago, and the gentleman has remained quite well ever since, and without manifesting any symptoms whatever of a return to the albuminous diathesis. It should be borne in mind, that in the dropsical diathesis there is a tendency to the secretion of water loaded with albumen, not only in the kidney, but also into the cellular membrane and serous cavities. It is rather difficult to conceive, that when the general system takes on this diseased action, the kidneys should be exempt, or that the kidneys should become affected with organic disease, in order to pour out albumen, while other tissues and organs can assume the same function without any structural alteration. Why should the kidneys alone become changed, while other parts retain their organic constitution? Dr. Graves said that he thought a few observations on this point would not be out of place. The Profession were in general aware, that modern discoveries have shown that the cortical portion of the kidney consists of an immense number of very minute tubes convoluted on each other, blending, and lying in apposition with the ultimate ramifications of the arterial capillaries, through the parietes of which the urine is separated from the blood, making its first appearance in the minute tubes of the cortical substance. Now what are the chief constituents of urine? water, salts, and various acids, as the phosphoric, nitric, &c. Now if the nascent principles of the urine are secreted into these minute tubes in company with nascent albumen, the latter will be inevitably coagulated by some of the above-mentioned acids, and if this process be often and continually repeated, it is not surely a very improbable result, that these tubes may ultimately become filled with coagulated albumen, a fact observed by Valentin We quite agree with Dr. Graves that albumen in the urine is not necessarily indicative of serious disorganization of the kidneys. Every physician and surgeon must see cases of albuminous urine cured. But, whilst we allow this we must say that, in the great majority of instances, the symptom must be deemed a serious one, and, probably, the sign of that state of kidney which will end in organic alteration-a state akin to an inflammatory one. 7. State of the Lungs in Hooping-cough.-A child died of hooping-cough, following bronchitis. The right lung was chiefly affected. It had occupied more than its natural share of the cavity of the thorax, and had pushed the opposite lung towards the left side. It exhibited subpleural vesicles, and other evidences of emphysema; but the most remarkable circumstance connected with it was the existence of pneumonic inflammation affecting not the central portion of the lung, but merely the margins in which the induration of the pulmonary tissue was obvious. 8. True Aneurysm of the common Iliac Artery, opening into the common Iliac Vein. Mr. Adams exhibited a specimen which bore some resemblance to the case recorded by Mr. Symes. It was a fusiform dilatation of the common iliac artery, with a communication between it and the common iliac vein. It appeared to be of several years standing, and to have caused the patient a good deal of distress. Some time ago he fainted while walking, and was carried home in a state of syncope, and died shortly afterwards. He had for a long time before death noticed a tumor, attended with a purring sensation in the lower part of the abdomen on the right side. On examination after death, Mr. Adams discovered a fusiform dilatation of the common iliac artery, and on one side of it there was a small opening about the size of a goose-quill, by which it communicated with the corresponding vein. Mr. Adams said he had examined the interior of the artery at the dilated portion, and could not find any solution of continuity in the lining membrane, except when the sac had opened into the iliac vein. He was therefore induced to look upon the preparation as being in the first instance a specimen of true fusiform aneurysm, and secondly, as affording an instance of spontaneous varicose aneurysm. MR. SMITH ON THE DIAGNOSIS AND PATHOLOGY OF FRACTURES OF THE One of the most remarkable memoirs we have lately read, is by Mr. Robert William Smith, lecturer on surgery at the Richmond Hospital School of Medicine, on Fractures of the Neck of the Femur. It is contained in the number of the Dublin Journal for September, 1840, and will amply repay the perusal of the surgeon. The memoir itself occupies seventy pages, and we must refer those who would become acquainted with the subject in detail, to it. We can do no more than present the conclusions which Mr. Smith draws from the facts. These consist in the post-mortem examination of fifty specimens of fracture of the neck of the femur, forty-two of which he relates. He deduces, then, the following conclusions: 1. A slight degree of shortening, removable by the extension of the limb, indicates a fracture within the capsular ligament. 2. The degree of shortening, where the fracture is within the capsular ligament, varies from a quarter of an inch to one inch, or one inch and a half. 3. The degree of shortening, when the fracture is within the capsule, varies chiefly according to the extent of laceration of the fibro-synovial folds which invest the neck of the femur. 4. In some cases of intracapsular fracture the injury is not immediately followed by shortening of the limb. 5. This absence of shortening is generally owing to the integrity of the fibrosynovial folds. 6. In such cases the retraction of the limb may occur suddenly, many weeks after the receipt of the injury. 7. This sudden retraction of the limb, which indicates a fracture within the capsule, is, in general, to be ascribed to the accidental laceration of the fibrosynovial folds. 8. The degree of shortening, when the fracture is external to the capsule and not impacted, varies from one inch or one inch and a half to two inches or two inches and a half. 9. When a great degree of shortening occurs immediately after the receipt of the injury we usually find a comminuted fracture external to the capsule. 10. The extracapsular fracture is generally accompanied by fracture with displacement of one or both trochanters. 11. The intracapsular impacted fracture is generally accompanied by fracture without displacement of one or both trochanters. 12. In such cases the fracture of the processes unites more readily than that of the cervix. 13. The degree of shortening, when the fracture is impacted, varies from a quarter of an inch to one inch and a half. 14. The exuberant growths of bone met with in these cases have been by many erroneously considered to be merely for the purpose of supporting the acetabulum and the neck of the femur. 15. The difficulty of ascertaining crepitus, and of restoring the limb to its natural length, are the chief diagnostic signs of the impacted fracture. 16. The position of the foot is as much influenced by the obliquity of the fracture and the relative position of the fragments, as by the action of the muscles. 17. Inversion of the foot may occur in the intracapsular, extracapsular, or impacted fracture of the neck of the femur. 18. When in the intracapsular fracture the lower fragment is placed in front of the upper, the foot is usually inverted. 19. When in the extracapsular fracture with impaction, the superior is driven into the inferior fragment, so as to leave the greater portion of the latter in front of the former, the foot is generally inverted. 20. In cases of comminuted extracapsular fracture without impaction, but with separation and displacement of the trochanters, the foot may be turned either inwards or outwards, and will generally remain in whatever position it has been accidentally placed. 21. The consolidation by bone of the intracapsular fracture is most likely to occur, when the fracture is also impacted. 22. Severe contusion of the hip-joint, causing paralysis of the muscles which surround the articulation, is liable to be confounded with fracture of the neck of the femur. 23. The presence of chronic rheumatic arthritis may not only lead us to suppose that a fracture exists when the bone is entire, but also when there is no doubt as to the existence of fracture, may render diagnosis difficult as to the seat of the injury with respect to the capsule. 24. Severe contusion of the hip-joint, previously the seat of chronic rheumatic arthritis, and the impacted fracture of the neck of the femur, are the two cases most liable to be confounded with each other. 25. Each particular symptom of fracture of the neck of the femur, separately considered, must be looked upon as equivocal: the union of all can alone lead to correct diagnosis. MR. DONOVAN ON THE HYDROCYANOFERRATE OF QUININA.* This salt has been brought forward by Signior Bertozzi, of Cremona, as a substitute for sulphate of quinina, where that fails. Doctors Zaccarelli and Carioli have confirmed his statements and anticipations. Mr. Donovan gives directions for procuring the salt, for which we must refer to our contemporary. The hydrocyanoferrate of quinina, when in small fragments, is of a pea-green colour; its taste is intensely bitter; it dissolves in cold, but better in hot alcohol, and is precipitated almost entirely from the solution by water. In prescription, it would be an error to promote its solution in water by means of dilute sulphuric acid, as is done in the case of sulphate of quinina; the salt would be decomposed by this acid, and the solution would become blue. It ought not to be prescribed with tincture of cinchona, and consequently not with infusion or decoction. The dose given by Doctor Zaccarelli, was equal to three grains and a half troy, repeated according to necessity. Although this febrifuge is precipitated by water from its alcoholic solutions, it separates in the state of so fine a powder, and remains so long suspended, that it will answer for exhibition very well in this state. The following formula will be found convenient: In pills R Hydrocyanoferratis quininæ grana quatuor, Adde aquæ, vel Misturæ camphoratæ drachmas septem. Misce fiat haustus, ut res nata sit, phialâ prius agitatâ, sumendus. R Hydrocyanoferratis quinine grana viginti quatuor, fiat massa quam divide in pilulas duodecim. These pills will be of a proper size, and two of them will constitute a dose; to be repeated according to the discretion of the prescriber. Mr. Donovan thinks the liquid form the better. He recommends, and so do we, the medicine to the profession. MR. DONOVAN ON COD-OIL.† It appears that cod-oil has been a good deal used, of late, in France and Getmany, in certain scrofulous cases. They say that, when properly administered, cod-oil cures scrofula of the bones, marasmus, and chronic arthritis of a scrofulous or rheumatic form. Caries, accompanied by a sore and swelling of the soft parts, requires the treatment with oil to be seconded by local applications, such as compression, and ioduretted alcoholic fomentations, cod-oil is of no avail against gouty arthritis, or swelling of any lymphatic glands but those of the abdominal cavity; its action seems doubtful or null in scrofulous phthisis when at all advanced. To produce advantageous results, in any disease, the use of cod-oil must be persevered in for several months, in doses of three or four table-spoonfulls daily. Now, if this be all true, cod-oil is no bad thing, and it would be well to have it as good as can be got. Perhaps it should not taste exactly like train-oil, as that might make one sick, if it did nothing else. So Mr. Donovan has perfected the process for its preparation, and made cod-oil a very respectable oil to take. * Dublin Journal, July 1, 1840. † Ibid. |