MALFORMATION OF THE ESOPHAGUS.*

This case is communicated to our contemporary by Mr. Mellor, of Charltonupon-Medlock, near Manchester.

"In the month of August 1839, Mrs. P., the mother of four healthy children, was delivered of her fifth, a fine, well-formed infant, after a perfectly natural labour of a few hours' duration. When in due time the infant was put to the breast, it was observed that the nipple was scarcely retained in the mouth beyond a minute, when the little creature became apparently convulsive, and almost instantly rejected the nutriment which it had taken. On my subsequent visit I was made acquainted with the above particulars, when I felt disposed to assent to the opinion expressed by the mother, that flatulency might be the cause of the symptoms, and accordingly prescribed a simple carminative. This was almost immediately rejected, as the milk had been, the infant notwithstanding manifesting the greatest eagerness to supply its instinctive wants. Inferring the existence of some obstruction in, or malformation of the oesophagus, I attempted to pass a common bougie, which however proceeded only for a very short distance, and then became curved upon itself, apparently not having arrived further than the commencement of the oesophagus. Matters went on in this way for six days, no other evacuation having taken place from the bowels than the meconium, and the infant continuing to apply its mouth to the breast with no other result than that of a slight convulsive paroxysm so soon as the pharynx became filled, and the immediate repulsion of its contents. Early on the morning of the seventh day it died, when a post-mortem examination disclosed the existence of little more than the membranous pouch of the pharynx, which terminated in a cul-de-sac a little below the cricoid cartilage, no trace of the oesophagus being visible beyond this part. The stomach presented no deviation from its ordinary form and dimensions, with the exception of its cardiac orifice, where there existed a slight bulging at the part corresponding with the termination of the gullet, and which was firmly united to the diaphragm. Further, a probe, introduced at this aperture, could not be made to pass into the stomach. Between this point and the sternum not the slightest trace of œsophagus, or any bond of connexions whatever with the pharyngeal portion, existed. The stomach contained nothing but air and a little mucus; the other viscera appeared perfectly normal.

In juxta-position with the foregoing case of defective conformation, I may mention an instance lately communicated to me by Mr. Heath, a highly respectable practitioner of this town. In this, the infant, which was of ordinary size, presented symptoms very analogous to those above described, and survived until the eighth day. On inspection after death, the duodenum was found obliterated to the extent of an inch or more, no further malformation having been observed."

ANALYSES OF THE MINERAL WATERS AT BRIGHTON.

We extract the following Table from a pamphlet recently published by Mr. Pickford, on the Artificial Mineral Waters prepared at Brighton. So many invalids are sent to that watering place, that it may be useful to many of our readers to see, at a glance, the composition of the waters prepared there.

* Med. Gazette, June 26, 1840.

No. LXVI.

PP

TABLE OF ANALYSES OF SOME OF THE PRINCIPAL MINERAL WATERS PREPARED AT THE ROYAL GERMAN SPA, BRIGHTON.

Grs. of Anhydrous Ingredients

Schlesi

Carlsbad. Ems. Marienbad Kissigen. Saratoga. scher. Eger. Pyrmont. Spa. 7.2712 8.0625 5.3499 0.8261 7.6211 0.8914

Pullna. Seidschutz

0.5531

0.0150

....

1.9500

1.1287

Ditto of Strontia.

0.0154

0.0347

0.4329 0.3104 0.2908 0.1609 0.1112 0.2423 0.3548 0-3727 0.3739 0.1320 0.0900 31.4606 16.0525 49.6417 56-7136 32-745214-7309 31.6670 15-4221

3-2691 188-4806 98-0133

INFLUENCE OF THE LEFT BRONCHUS IN CLOSING THE DUCTUS ARTERIOSUS.*

Mr. T. W. King, Curator of the Museum of Guy's Hospital, advances the following hypothesis to account for the rapid closure of the ductus arteriosus after birth.

"In fœtal life the air-tubes contain only a little fluid; they are probably but partially expanded, while the circulation is nearly single and equable, the auricles pretty equally full at all times, and the ventricles equally powerful. The chest continues of limited capacity; the diaphragm high, and the lungs confined about the heart. We may now reflect upon the principal effects of the first inspiration: a general expansion is made, which is never again to have its commensurate collapse; and, although that fulness of the lungs (as to air) which may be regarded as necessary and permanent, be not obtained till later, it seems pretty evident that the first inspirations must have a far larger share than any others in effecting this condition. Now the trunk becomes straighter; the neck is no longer bent forwards on the breast, and the trachea is elongated; the diaphragm, and with it the heart, is considerably drawn down, while the lungs are generally expanded, but most particularly outwards: and one particular result of all these changes, I imagine to be, that the left bronchus is rendered more full and tense, and also raised at the same time that the ductus arteriosus is drawn down with some force, and perhaps with some disposition to elongation. In fine, it is to the sudden and intimate cross contact of these two tubes that I would mainly attribute the closing of the blood-vessel, which is in a manner bent over the bronchus, and has also a more oblique direction given to its communication with the aorta."

We confess that we are inclined to attach more importance to the indraught of blood into the lungs, which inspiration must occasion, than to the mere stretching of the bronchus. Our readers, however, will judge for themselves. Mr. King's view is certainly ingenious.

RUPTURE OF THE HEART INTO THE PERICARDIAL SAC. LIFE FOR TEN

HOURS.

Dr. Stroud relates the following case.

Case.-Frederick P., aged 29, after anxiety and vexation endured for a considerable time, and after having been liable to profuse bleeding of the nose, during the spring season, for many years, was, on the non-occurrence of this bleeding, subject for six weeks to a sense of fulness in the head, with lassitude and somnolency. On the morning of April 27, 1839, after having returned from Covent Garden Market, he was seized with faintness, giddiness and vomiting, and insensibility. The pulse became imperceptible, and he was apparently in a dying state. He was promptly bled by Mr. Symes, to three pints, recovered a little, continued complaining of great tightness of the chest, and weight at the heart, but died the same evening.

The pericardium contained a quart of blood which had escaped through an opening in the right auricle just below the insertion of the vena cava superior, the edges of which were not attenuated or apparently ulcerated. The author accordingly suggests the prudence of relieving plethoric oppression, even where signs of structural disease in the sanguiferous system are not evident. In this patient the heart was large, and loaded with fat.-Med. Gaz. June 19, 1840.

* Med. Gaz. July 10, 1840.

RESOLUSIONS OF THE MEDICAL ASSOCIATION OF IRELAND.

The following are the principal Resolutions of this young, but, perhaps, powerful body.

Dr. G. W. O'Brien, of Ennis, moved the fifth resolution, viz. :-ResolvedThat the objects of the Association are

1. To form a society for the protection of Medical Practitioners in all their just and legal rights:

2. To seek for a Legislative enactment, giving a permanent constitution to the Profession, and directing a competent and uniform standard of Education, and an equality of privileges for all persons who shall, in future, be permitted to practise medicine throughout the Empire, and

3. To secure for the public, in future, the services of a scientific Apothecary, who shall be protected in the exercise of his Profession, and not engage in the practice of Medicine.

Dr. Purcell, of Carrick-on-Suir, moved the sixth resolution, viz. :-Resolved -That the Council be directed to prepare a Petition to Parliament, for the enactment of a measure which shall provide for the regulation and control of the Medical Charities; also praying that adequate funds shall be provided for their support.

Dr. Jagoe, of Kinsale, moved the seventh resolution, viz. :-Resolved-That the Council be directed to prepare Petitions to Parliament for suitable remuneration to medical men, when called upon to perform public services in courts of justice.

Dr. Cranfield, of Enniscorthy, moved the eighth resolution, viz. :-Resolved -That the Council be instructed to prepare Petitions to Parliament, praying for attention to the neglected subject of Medical Police, and for encouragement to medical men disposed to engage in the investigation of all matters concerning the public health; and that copies of these different petitions shall be forwarded to each Local Secretary, in order to procure signatures in all parts of Ireland.

Dr. Cane, of Kilkenny, moved the ninth resolution, viz. :-Resolved-That the following plan of General Medical Reform shall be supported by this association :

The establishment, by law, of one Faculty, having three branches, one in each of the capitals of the Empire; such Faculty to include all Practitioners in Medicine, both Physicians and Surgeons: each Branch to be governed by a Representative Council, elected periodically by and out of, the whole body of the Faculty in each Kingdom. The Councils to have the power of making regulations for the government of the Profession, and also of admitting Members: no person being permitted to practise without being examined and licensed as a Member of the Faculty. The regulations of the three Councils to be similar and uniform, general conferences being, from time to time, held in order to preserve uniformity. This One Faculty' plan contemplates the establishment of a class of scientific Apothecaries to be examined and licensed as such under the direction of the Councils; also, that no Practitioner "shall be permitted to sell drugs, or to compound medicines, unless prescribed by himself, or by others in consultation with him, and for his own patients, except in rural districts, and by special license." Mr. Donovan's proposal for establishing a College of Pharmacy, might, with some modifications, be made to coincide with this portion of the One Faculty' plan. Institutions for teaching not to be connected with the licensing body of the faculty.*

* Med. Gaz. June 19, 1840.

REMOVAL OF PART OF THE SPHINCTER FOR PROLAPSUS ANI.

M. Robert, reflecting on the inadequacy of excision of the prolapsed mucous membrane, as a curative measure, conceived the idea of removing some of the sphincter. A bad case presented itself in June, 1839. A washerwoman, aged 33, in St. John's ward, at La Pitié. The woman, when pregnant for the third time, had a prolapsus recti which was but temporary, and only occasioned a supportable degree of discomfort. Her fourth pregnancy brought on a prolapsus of the uterus, a permanent and very considerable prolapsus of the rectum, and a relaxation of the parietes of the abdomen. M. Roux now excised a prominent portion of the mucous membrane of the rectum. This somewhat relieved her; but the prolapsus soon increased; the fæces came away involuntarily, and she had pains in the loins, and the upper part of the thighs. This combination of symptoms confined the patient to her bed, and in June 1839 she was admitted into the Pitié. At that time the sphincter was so relaxed that four fingers could be easily introduced. The patient having been prepared by a progressive diminution of diet, and the use of opium, so as to produce as long a constipation as possible, M. Robert proceeded to operate in the following manner :-He made an incision on each side of the anus, beginning several millimétres from the middle of the aperture, and directed backwards to the point of the coccyx. The flap of skin between the two incisions was removed, together with the portion of the sphincter which it covered; and half the length of the muscle was thus removed. The two sides of the wound were united by three stitches of the twisted suture. The case went on well. In the month of August the patient walked, and passed her stools voluntarily; but a small bourrelet of the mucous membrane had already protruded, and though, twice touched with the actual cautery, was not destroyed. Yet the cure has been a lasting one.*

LEECH GATHERING IN RUSSIA.

One of the branches of industry prosecuted here is singular enough; it is the gathering of leeches for the Hamburg dealers. When talking with a person connected with this trade, we thought of Wordsworth's friend, of leech-gathering fame; but the collectors of the Ukraine do their work in such a wholesale, unpoetic way, that Wordsworth would not soil his verses with them. Having exhausted all the lakes of Silesia, Bohemia, and other more frequented parts of Europe, the buyers are now rolling gradually and implacably eastward, carrying death and desolation among the leeches in their course; sweeping all before them, till now they have got as far as Pultavia, the pools and swamps of which are yielding them great captures. Here a thousand leeches are sold for four roubles (3s. 4d.); at Hamburg, before reaching which one half die, the same number is sold for 120 roubles (near £5); and in England the country apothecary pays £9 and £12. 10s. for the quantity which originally cost only 3s. 4d. But of every thousand at least seven hundred die before reaching England.-Bremner's Excursions in the Interior of Russia.t

ADVANTAGES GRANTED TO NAVAL MEDICAL OFFICERS.

We are glad to perceive from Her Majesty's Order in Council, which has been