So important too is exercise in the open air considered by many, that Dr. Ferres has very justly remarked that a farm or large garden is an indispensable adjunct to every lunatic asylum.-Gazette Medicale.

M. BAUDENS ON GLANDULAR SWELLINGS.

M. Baudens, one of the most distinguished military surgeons in France, and who has been the surgeon of the hospital at Lille since he returned from the expedition to Constantine in Africa, where he was the chirurgien en chef, prefaces his remarks on the development of glandular engorgements by alluding to the influence of climate on this and other forms of disease.

"Under the cold and humid atmosphere of Lille and of the surrounding country, the energy of the exhalent vessels seems to be quite paralysed, while at the same time the absorbents of the surface, being kept as it were in a perpetual bath, are constantly receiving extraneous matters. Hence the retropulsion of the fluids from the surface by a centripetal movement, the abnormal development of the cellular tissue, the tendency to enlargement of the lymphatic glands, the disposition to rickets, phthisis, and scrofulous disease in all its forms, which so widely prevail among the population of Lille."

It seems that the moisture of the atmosphere at Lille is, as appears from the hygrometer, at least as great again as that at Paris.

M. Baudens alludes to the damp state of the houses, the neglect of flannel clothing, and the insufficiently nutritious diet of the people, as powerful adjuvants in relaxing the general constitution, and predisposing it to the class of maladies above-mentioned. " 'The Englishman," he adds, "who lives in a cold and foggy climate, braces himself against its hurtful influence with his rosbif; we should imitate his example."

He attributes much of the disease among the troops to the insufficient allowance of nutritious animal food to the men. Want of due bodily exercise is another reason:

"The movements of the limbs in active exercises, and the continued occupation of the mind, must very efficiently second the good effects of a more abundant and more animalised nourishment. A proof of this we see in the case of cavalry soldiers, who, in consequence of their more active and energetic employments, are much less frequently on the sick-list with glandular complaints than the infantry soldiers."

The influence of the seasons on the development of this class of diseases is also great.

Tolerably rare during the three Summer months, they re-appear with the fogs, cold, and dampness of Autumn; but it is chiefly during Winter that they increase with such a prodigality that we have often counted nearly 80 patients in our military hospital, which usually contains only 300 sick, affected with inflammatory glandular enlargements (adenites.)"

The groupes of glands most frequently inflamed are the cervical and maxillary : occasionally the testicle has been similarly affected at the same time; and in not a few cases this gland has begun to swell and become painful as the lymphatic glands began to subside; while in others the orchitis was primary and the affection of the cervical glands was secondary. The management of these varieties of the disease is sufficiently easy during the early stage: the use of antiphlogistics, purgatives, and sudorifics, generally suffices to remove all such inflammatory swellings. The difficulty consists in effecting a resolution of the glandular tumors, when they have become fairly chronic.

M. Baudens prefers the use first of blisters over the part to any other local remedy, and then of ioduretted mercurial embrocations. Compression is often

a most valuable adjuvant. The following novel method of applying this in swellings of the testicle has succeeded in the practice of M. Baudens.

"I had the gland inclosed in a bottle of caoutchouc, which by its elasticity kept up so steady and methodic a compression that at the end of a month's use I had the gratification of seeing a radical cure of the enlarged testicle-which had been diseased for two years, and which would certainly have been extirpated if it had not been that the inguinal glands were seriously affected at the same time."

M. Baudens mentions favourably the hydrochlorate of barytes and the preparations of iodine, as useful remedies for internal administration. A generous diet should be allowed at the same time. Whatever tends to fortify the general system, and to give tone and energy to the blood-vessels, will be found to promote the success of our remedial treatment. It is often of marked service in obstinate cases to recur to the application of blisters, often omitting their employment for some time.-La Lançette Française.

ON THE TREATMENT OF CERTAIN CASES OF DEAFNESS.

M. Petrequin, surgeon of the Hôtel Dieu at Lyons, has communicated to the French Medical Gazette a lengthened paper on those cases of deafness which are connected with, and not unfrequently induced by, affections of the throat and nostrils. He first discusses the use of the different parts of the ear;-take, for example, what he says of the uses of the Eustachian tube.

"

It serves as an excretory canal for the fluid secreted within the tympanum, which would otherwise accumulate and interrupt the sense of hearing, (as is the case when the tube becomes obstructed from disease); hence this office justifies its appellation of aqueduct of Eustachius.

2. It serves to establish a uniform degree of heat in the air contained in the tympanum, and thus prevents the disturbance of the functions of the component parts of this cavity.

3. It serves to maintain in this air its proper hygrometric condition.

4. Its principal use is to keep the air in the tympanum in a state of equilibrium with the external air, so that its membrane may vibrate accurately, and communicate the impulses of the air on each vibratory movement.

It is well known that a common drum, in order that it may give out a proper sound when played on, must have an opening in its side to give entrance and exit to the air; so it is with the drum of the ear; if the Eustachian tube be obstructed, the membrana tympani ceases to vibrate with the impulses of sound, and thus the sense of hearing becomes more or less entirely obscured.

The circumstance too of many deaf people hearing better when their mouth is open may be accounted for by the readier admission which is thus given to the air, along the Eustachian tube, and also by the slight enlargement of the outer auditory passage, in consequence of the motion of the condyles of the jaw.

Again; it is from the admission of too large a quantity of air along the tube in the acts of yawning and sneezing that sometimes occasions a momentary deafness and sense of tickling in the ear; whereas, after very loud sounds, such as from the explosion of fire-arms, we not unfrequently experience a tickling in the throat and mouth-in consequence of the air within the tympanum being driven outwards with unusual force. Hence cannoneers are often in the habit of keeping their mouths open while firing off artillery.

From all these circumstances it may be readily understood how any morbid affections of the tympanum and of the Eustachian tube must necessarily interfere with the sense of hearing. Now the Eustachian tube very generally suffers

in all chronic diseases of the pharynx and throat; and hence the importance of examining the fauces in all cases of deafness."

M. Petrequin details the particulars of numerous cases where the deafness had been preceded or was attended by some chronic inflammation of the throat, and in which a cure was effected by the use of alum gargles, of insufflations of a powder consisting of equal parts of alum and sugar twice a day, and occa. sionally by rubbing the fauces with a stick of alum.

The deafness, arising from an obstructed state of the Eustachian tube, may generally be suspected whenever it has followed upon any affection of the throat. It is most commonly met with in persons who are subject to catarrh, cynanche, and coryza; also in those who have suffered from syphilitic, dartrous, or rheumatic complaints. The affection of the tube is necessarily much more obstinate than that of the throat, and it often exists quite unsuspected. The deafness caused by it usually varies in degree according to the state of the weather and the season of the year, being always greater when the air is cold and moist, and less decided when it is dry and warm. A fit of sneezing or of yawning too will often relieve the deafness more or less, for a short time, the patient experiencing at the moment a sensation as if a bottle was uncorked in his throat: this may be caused by the expulsion of some firm mucus plugging up the tube. This kind of deafness is always much increased, if coryza or any form of cynanche is present; and lastly, we may add that, "if during a strong expiration, while the mouth and nostrils are closed, the person is not sensible of the air passing along the tube and distending the tympanum, we have good grounds for suspecting that the former is obstructed."

Deafness from this cause is not unfrequent in youth and in middle age; perhaps however it is still more common in old people, as it is well known that in them few of the mucous passages are quite exempt from some morbid change. In cases which resist the treatment recommended above, the catheterism of the Eustachian tube should be practised at the same time: this operation is far from being so difficult as many writers have imagined. But very generally M. Petrequin has succeeded with the use of the alum, in the form of gargle, and of dry insufflations to the back of the throat. The gargle should be used frequently in the course of the day, and be retained in the mouth for a considerable length of time, so that the alum may affect the mucous membrane, and its operation be gradually communicated towards the opening of the posterior fauces. The insufflation of the dry powder, consisting of equal parts of pulverised alum and sugar, should be employed twice a day; and to render its operation still more effectual, it will be found very useful to rub gently with a stick of alum the tonsils, velum, and fauces, every three or four days.

Under the influence of these several means the engorgement of the throat gradually subsides, and a more healthy action of the mucous membrane is established.

"Experience has already testified in favour of the aluminous medication; MM. Pommier and Bretonneau have recommended it strongly in cases of diptherite, M. Bennati in various affections of the vocal organs, M. Velpeau in diseases of the throat, and I myself have used it with great success in many forms of ophthalmia."-Gazette Medicale.

Remarks.-M. Petrequin is quite correct in ascribing numerous cases of deafness to affections of the Eustachian tube, and in stating that these affections are very often primarily attributable to a chronic inflammation of the fauces, which has gradually extended itself upwards to the posterior nostrils. An excellent, and a still more potent, substitute for the alum, as recommended by M. Petrequin, is the nitrate of silver. This is to be used in the form of solution, and the posterior fauces should be freely wetted with it, every three or four days, by means

of a sponge fastened to a probang. A gargle, containing the hydriodate of potash, has also in several cases been used with decidedly good effects.

The internal administration of the same salt, along with sarsaparilla, may be most advantageously combined with the employment of local means, when the constitution is decidedly scrofulous, or suffering from the effects of the syphilitic disease.-Rev.

REMARKS OF A GERMAN ON ENGLISH OBSTETRICY.

"In general the English physicians are much less disposed than their brethren on the Continent to perform operations, and trust more on all occasions to the efforts of nature. This will appear when I mention that Clarke, during the seven years that he was accoucheur at the Dublin Institution, states that in 63 cases only out of 10,199 deliveries was the employment of any instruments resorted to, and that Collins, the late master of the same extensive charity, had recourse to them only 145 times in 16,654 cases. This unwillingness to employ any forcible means, unless peremptorily required, arises no doubt from the slight importance attached by the English to the life of the infant compared with that of the mother. Hence the frequency with which embryotomy is performed, and the comparative rarity of the use of the forceps; and, as to the Cæsarian operation, that is never thought of, except where the child cannot be extracted even after the head has been perforated. (Strange that it ever should.-Rev.) As to the mortality among the infants, 1121 out of 16,654 were born dead during the mastership of Dr. Collins. Of 97 cases in which there was prolapsus of the umbilical cord, 73 of the infants were born dead; the mothers did well in all these cases. Dr. Clarke, the predecessor of Dr. Collins, has told us that only 17 children out of 66 cases, where there was prolapsus of the cord during labour, were born alive. The mortality among the women seems to be very small; for of 16,414 who were delivered in the institution during Dr. Collins' mastership, only 164 died; although during this time there had been an epidemic of puerperal fever.

In cases of uterine hæmorrhage, the English accoucheur relies chiefly on a speedy extraction of the placenta after the child has been delivered in usual, the placenta is never allowed to remain longer than one hour after the accouchement. The employment of firm compression of the hypogastrium, of cold applications or douches, and the introduction of the hand into the cavity of the uterus, are generally resorted to in this form of hæmorrhage. What are considered by far the most potent internal remedies are opium and spirituous drinks, whenever there is any tendency to syncope.

It is only in the last extremity that Mr. Kennedy has recourse to the use of the forceps in the case of puerperal convulsions: he very generally trusts to the efforts of nature. In 15 out of 30 cases of convulsions-and of these 24 were first-labour cases-the delivery was spontaneous; in six it was effected with the aid of the forceps; in eight the perforator was used; and in one only turning was performed. Of the 30 children, 14 only survived. Of the eight women, in whose case embryotomy was performed, five died."—Neue Zeitschrift fur Geburtskunde.

ON EPIDEMIC HEMERALOpia.

Dr. Henry, surgeon of the French Frigate Dido, which has recently returned from its surveying voyage round the world, has communicated some observations on this species of amaurotic blindness, which is not unfrequently met with in

tropical climates. The following extracts are from a report made by him to the Council of Health at Brest.

"A remarkable circumstance occurred during our voyage from St. Domingo to Martinique; it was the epidemic appearance of a complaint of frequent occurrence in the tropics, hemeralopia. A few scattered cases had indeed already appeared during the previous part of the voyage; but now a number of our crew became almost suddenly affected with night blindness-in consequence probably of our prolonged stay at sea under the dazzling rays of an equatorial

Dr. Henry applied himself to ascertain the real cause of the complaint. He quite rejects the idea of some, that it is the result of any miasmatic influence, for the Dido was and had been for some time at sea; of others, that it is occasioned by imperfect nourishment, as the crew were upon fresh provisions at the time; or by the moisture of the atmosphere, any unwholesomeness of the night air, or by the noxious effect of sleeping in the moonshine (a popular idea). He feels assured himself that the real cause of the blindness is altogether owing to the dazzling effects of the intense solar light reflected from smooth shining objects, such as the sea, tracks of sand, &c. Hence it is more common at Lavalette in Malta and at Cadiz than at Martinique or Guadaloupe, because the two former cities are built upon and surrounded with a sandy coast, whereas the latter have extensive and shady forests all around them. We cannot therefore hesitate to admit that it is to the intensity of the brilliantly reflected light from the smooth surface of the tropical sea giving rise to an atony of the retina that we are to attribute the sudden appearance of so many cases among the sailors of the Dido at the period of her voyage above mentioned. The following remarks on the symptoms of the disease are interesting.

"The symptoms of night blindness are often very indistinct. Generally indeed the pupils are considerably dilated, and lose in a greater or less degree their contractility; sometimes the eye is painful, at other times it is quite free from all uneasiness. . . . . . We have not observed that this malady is attended, as has been asserted by Bampfield, Dupunt, Scarpa and others, with vertigo, headache, redness of the face, or any gastric or intestinal disturbance. In our practice it has presented itself free from all complication, and has almost always been primitive and isolated. The accession of the complaint is usually gradual, At first the sight has become indistinct and obscured by, as it were, a thin veil before the eyes, after the setting of the sun; this indistinctness increases more and more by degrees, and at length terminates in total blindness. I observed that in those patients, in whom the iris was blue or grey, the pupil was always more dilated than in those whose eyes were dark; and moreover that the disease was much more common in the young sailors, who had never been in a tropical climate before, than among the old and seasoned part of the crew."

We need scarcely mention that the complaint is comparatively very rare among the officers of a ship's crew; their duties not exposing them, like the sailors, to the unprotected action of the sun's rays.

As to the prognosis in hemeralopia, it is almost always favourable, provided the patient be withdrawn from its exciting cause, and especially if a change be made to some other latitude where the light is less dazzling and overpowering.

"We have observed in between 30 and 40 cases the duration of the complaint has been from eight to fifteen days, which in others the restoration of

Dr. Henry mentions that almost every one of the unfortunate French prisoners of war, so inhumanly left by the Spaniards on the island of Cabrera (Baleares)—where they were badly fed, still worse sheltered, and exposed to the heat of an African sun, on a sandy coast where there was little or no vegetation -became affected with hemeralopia.