the head; pupils dilated; tongue preternaturally red, more so at the tip, rather dry. Skin hot and dry; respiration short and laboured; has cough; expectoration sero-mucous, of a brownish tinge, slightly tenacious; pulse 120, weak and compressible; tenderness of the epigastrium; pain upon pressure. Abdomen tumid; bowels constipated; have not been open for a week. She was ordered a drachm of pulv. camph., tinct. opii, gtt. xxxvi., syrup. tolu, 3 ij., muc. acac. q. s. ut fiat 3 vj. 3 ss. omni horâ: enema; two ounces of wine during the day; beef tea, and pedil. sinap. P. M. Expression dejected; pupils natural; eyelids falling down; incoherent; sees things double; imagines that she sees soldiers entering the cell, and rats running about it; very much afraid of being left alone; breathing more natural; cough less; tongue the same as this morning; pulse 100, still feeble, easily compressed; skin cool and dry; pain and soreness on pressure in the epigastrium; pain in the back and loins; feet cool; hands rather warm. 25th, A. M. Expression dejected; eyes dull, and wanting expression; pupils natural; tongue not so red, more natural, moist; coughs much; expectorates freely; respiration 24 in the minute; under the left clavicle on percussion resonant. Slightly so on the right side. Under the left clavicle respiration rude and blowing; under the right blowing. Right posterior superior scapular region, pectoriloquy and bruit de frottement; on the left posterior superior scapular region respiration bronchial; pulse 110, weak and compressible; skin warm and slightly moist; pain upon pressure over the sternum and chest; pleurodyne; soreness and tenderness upon pressure over the epigastrium; abdomen tense; passes her water freely; bowels open; slept two hours. Continue treatment. 25th, P. M. Somewhat improved; pulse 88; in every other respect the same as at the morning visit. Discontinue treatment. 26th, A. M. Slept five hours; appearance rather improved, expression more lively; no tremors; pulse 100; tongue clean, natural. 26th, P. M. Expression very much improved; skin warm and dry; pulse 102; tongue natural. 27th, A. M. Expression better; pulse 100; bowels regular; coughs much; expectorates muco purulent matter; skin moist and natural. Ordered R. syrup tolu. 3 iv., gum ammoniaci 3 ss., muc. acac. q. s. ut ft. 3 vj. 3 ss. q. h. 27th, P. M. Expression dejected; no illusions; tongue moist and red; has severe darting pains in the side when she coughs; soreness of the abdomen and epigastrium still continues; pulse 112, very weak and feeble. Skin cool and dry; bowels open four times during the afternoon; ordered three ounces of wine during the night. 28th, A. M. Illusions entirely gone; slept three hours; quite convalescent. Transferred to the Medical Ward for the treatment of her other affection. CASE 4.-Margaret Green, æt. 29, entered on Monday afternoon, Nov. 29, intoxicated. 8 o'clock, P. M., present state.-Perfectly sane; skin hot and moist; tongue moist and coated; pulse 108, and very strong; slept three hours during the afternoon. No treatment. 30th. Slept six hours; face flushed; pupils dilated very much; tongue still coated and moist; slightly red at the tip; pulse 64, weak, thready; bowels freely open; slight tremors, 30th, P. M. Expression lively; intelligence clear, no hallucinations; tongue clean. Pulse 60, small and feeble; skin moist; temperature natural. 31st, A. M. Slept six hours; rest undisturbed; feels perfectly well; tongue coated with a yellowish fur, red at the tip; pulse 64, full and regular; skin warm and moist; slight tremors. 31st, P. M. Feels well; has good appetite; quite convalescent, November 1st, A. M. Slept 6 hours; feels low spirited and weak. No illusions; tongue natural; pulse 72, rather weak; skin warm and moist; had cold sweats during the night; bowels open frequently. P. Pulv. kino. gr. ij. ; plumb. acet. gr. j.; quâque secunda borâ. P. M. Feels lively; tongue moist; pulse 92, weak; skin warm and moist; bowels not open so often. 2d, A. M. Feels perfectly well; allowed to walk about. Discharged on the 3d, cured. BIBLIOGRAPHICAL NOTICES. Randolph's Memoir on Physick.1 This is a worthy tribute to one whose loss the profession and the public have had to deplore within the period embraced since the first establishment of this journal-one who,-as we on a former occasion expressed, and as has been constantly, now almost proverbially, expressed,-will ever be regarded as the "Founder" or "Father of American Surgery." It matters not whether this were the affair of circumstances, or of transcendent merits, or of both combined; such is nevertheless the fact. Dr. Randolph has not attempted, in the memoir before us, to indulge in that overstrained style of eulogy, which too often pervades such productions; he has endeavoured to afford us a view of the character of his distinguished relative, derived from long and intimate personal communication. No attempt at effect is perceptible in his pages. Every thing indicates the honourable, manly and independent principles which-his professional brethren will admit-characterise the estimable author. As regards the "getting up" of the book, we cannot say more than that, so far as we know, it exceeds any thing of the kind which has emanated from the Philadelphia press. New Remedies. In the Library department of the next number we shall commence, in alphabetical order, an account of "New Remedies," in which will be comprised those of modern introduction, with certain older agents that have in recent times received novel applications. The experience of practitioners at home and abroad will be referred to, and illustrative formulæ given at the end of each article. The country practitioner, especially, has some difficulty in obtaining precise information on the various uses of such agents as creosote, iodine, in its various forms, &c.-a deficiency which we shall attempt to supply. At the termination of the volume an index of diseases, &c. will be given. It is on the basis of Riecke (Stuttgart, 1837). Baltimore Almshouse.-We are glad to learn that, at a recent election, Dr. Robinson, of Baltimore, was elected one of the physicians, in conjunction with Dr. S. Annan, of that extensive charity. A Memoir on the Life and Character of Philip Syng Physick, M. D. By J. Randolph, M. D., Lecturer on Surgery, Member of the American Philosophical Society, one of the Surgeons to the Pennsylvania Hospital, Member of the Philadelphia College of Physicians, one of the Consulting Surgeons to the Philadelphia Dispensary, Honorary Member of the Philadelphia Medical Society, &c. &c. 8vo. pp. 114. MISCELLANEOUS NOTICES. Communicated for the "Intelligencer." Leeches. Sir: Allow me to avail myself of your widely circulated paper, to communicate a useful fact to the medical profession in the province. Leeches are of very great importance in medical practice, and so dear here (£1 10 0 dozen) as to put them beyond the reach of almost every one. We have a leech in this country abounding in every rivulet fully equal to the German leech, (Hirudo medicinalis.) There are three species of leeches at least in this neighbourhood, all confounded under the name of horse leech, viz.: the orange bellied, the black bellied, and the striped leech. I procured last week some of the orange bellied kind and sent some to the General Hospital, with a request to my friend, Dr. Campbell, to try them. He applied four of them to the eyelid of a girl labouring under ophthalmia, and the result was every way satisfactory; they fastened readily, caused no pain, drew plentifully, the bleeding stopped spontaneously when the fomentations were discontinued, and neither inflammation nor ecchymosis followed. This experiment was the more gratifying as the common leech will often produce irritation and ecchymosis when applied to the eyelid. I have since verified the above in private practice. The description of the animal is as follows. The back is dark bottle green, with three lines of minute dots, the centre one yellow, and the lateral ones black, the belly is a dusky orange, sometimes mottled with irregular black spots. They breed freely in confinement, and seem easily preserved. They sometimes require minute punctures to be made before they will fasten, and should be taken out of the water at least a half an hour before being used. The procuring of these animals will form a useful and profitable employment for the many idle lads that infest our streets, playing marbles, tops, &c., if not doing something worse. Hoping that these observations may prove of service. I remain, To the Editor of the Montreal Herald. Your obedient servant, Researches on Suppuration. By GEORGE GULLIVER, Esq., Assistant Surgeon to the Royal Regiment of Horse Guards.-(Phil. Magaz. S. 3, vol. xiii. No. 81, Sept. 1838.)-In this paper Mr. Gulliver adduces various facts to prove that, in inflammatory and suppurative fevers, it is possible to detect globules of purulent matter in the blood; and he consequently infers that the presence of these purulent globules is the cause of the peculiar symptoms observed in cases of this class,-in short, the proximate cause of the sympathetic inflammatory, sympathetic typhoid, and hectic fevers. The mode of examination was partly chemical, partly microscopical. As water acts rapidly and energetically on the blood-globules, dissolving them so as to render them invisible, while the globules of purulent matter undergo no change after being long kept in water; so while the blood-globules are diffused through the fluid, the globules of purulent matter fall to the bottom, where they may be easily seen, and their characters determined by means of a good microscope. Ammonia instantly renders the blood-globules invisible, while it acts slowly on the purulent globule; and acetic acid acts on the blood-globule and that of purulent matter in a manner equally characteristic. The microscope used for the purpose now specified was that with the deep object glass of Mr. Ross, already mentioned in the paper of Dr. Davy. To distinguish the globules of chyle from those of purulent matter, Mr. Gulliver observes, that it is necessary to remember that the medium diameter of purulent globules is ths of an inch, which is above twice that of those of chyle. In prosecuting this enquiry Mr. Gulliver employed evidence of two sorts. He first produced inflammation artificially in one or more of the tissues in brute animals, and he then recognised the presence of globules of purulent matter in the blood of one or other of the large veins. Thus in the blood obtained from the right ventricle of the heart of a dog, in which acute inflammation was produced by injecting a weak solution of corrosive sublimate into the cellular tissue of the thigh, in the blood of the vena cava of a dog, in which both tibia and the cellular membrane were inflamed, in experiments on necrosis, and in the blood of the inferior cava of a dog destroyed by peritonitis, artificially induced, globules of purulent matter were seen by the microscope. He also injected purulent matter into the pleura of one dog, into the peritoneum of another, and into the crural veins of other two dogs; and in the first two cases, and in the last, he detected the presence of globules of purulent matter in the blood after death. The second kind of evidence employed by Mr. Gulliver is that obtained from submitting to examination the blood of persons destroyed by various diseases, in which purulent matter is formed in the course of the disorder, as small-pox, peritonitis, suppurative inflammation of the leg, with inflam mation of the vein, pleurisy, diffuse inflammation of the thigh, and pulmonary consumption; and in the whole of these cases he found globules of purulent fluid in the blood of the chambers of the heart or large veins after death. The opinion originally founded on the microscopical observations of Mr. Hunter, Sir Everard Home, and M. Bauer, that the globules of purulent matter are merely globules of blood modified by the inflammatory process, as advanced by Sir A. Cooper, Dr. Young, and M. Gendrin, Mr. Gulliver seems disposed, in some degree, to consider probable. He does not, however, agree with the latter author in regarding purulent matter as a modification of fibrin; and he adds that, in regard to the Batrachian reptiles, he never could induce suppuration in their tissues after repeated trials; and he consequently does not agree with M. Gendrin in admitting the facility of observing the transformation of blood-gobules into globules of purulent matter. He thinks that the matter often found in the centre of clots of fibrine is not purulent but mere softened fibrine, which, though resembling purulent matier in some particulars, differs from it in chemical and microscopical characters. His notion of the nature of the process of suppuration is ingenious. He thinks that the experiments performed by him render it probable that it is a sort of proximate analysis of the blood. As the effused fibrine produces swelling, or is attracted to the contiguous tissue for the reparation of injury, the blood globules altered by stagnation become useless, and are discharged in the shape of purulent matter, as waste from the system. Suppuration, therefore, he thinks, may be a physiological rather than a pathological phenomenon, purulent matter being an excrementitious discharge, a part of the blood which has become effete and noxious during the reparative process, whether this process may have been employed in limiting the extent of an abscess, or in healing breaches of continuity. If, however, purulent matter be formed in the capillaries, in consequence of the stagnation and coagulation of their contents, this matter, he thinks, might be mixed in large quantities with the blood in cases where no declared or manifest suppuration has taken place. Regarding the observation of Mäller, that the smaller capillaries have only the diameter of a blood globule, he promises on a future occasion to show, from the result of experiments, that these vessels become sufficiently enlarged during inflammation to contain a row of purulent globules. To the remark, that purulent matter is often formed without any obvious addition of fibrine to the neighbouring parts, he answers, that this is not a healthy but a diseased form of suppuration; that in this kind of suppuration the fibrine is broken down, mixed, and excreted with the purulent matter, and hence are formed the flaky curdy masses so often associated with this form of suppuration. He also infers that the presence of purulent matter in the blood is the cause of the symptoms of irritation and fever generally observed in diseases in which inflammation proceeds to suppuration.' Anatomy of Club Foot.2-Although the malformations which are known under the popular denomination of club-foot are extremely frequent, and their treatment carried to a high degree of perfection, we possess but few accurate records of dissections of the affected limb. The following account of a case of talus, lately presented to the Royal Academy of Medicine by M. Bouvier, is therefore worthy of some attention : : It occurred in the person of a man, who died at the age of sixty-six years in the Hôtel Dieu. The malformation had been developed in this individual when at the age of twelve months, and consisted in a forcible extension of the foot, by which the weight of the body was made to fall entirely on the heel. The angle which is formed by the axis of the foot with the leg, is sixty degrees, and the point of the foot is with great difficulty brought down so as to form a right angle. When this is done the tibialis anticus, extensor communis, and extensor proprius pollicis muscles are thrown into a state of extreme tension. The integuments of the heel are thick and horny; those of the rest of the foot are fine and thin, showing that the heel had to bear the entire weight of the body. The os calcis is directed somewhat outwards; the whole foot also deviates outwards in a slight degree; the sole of the foot, instead of forming an arch, is nearly flat. The lateral peroneal muscles are shortened, but those which cover the back of the leg are elongated. The whole limb is remarkably wasted, the muscular fibres completely deprived of their colour, and presenting that peculiar fatty appearance which so often occurs in cases of club-foot. The operation of dividing the tendons, which has been practised with so much success in cases of children affected with club-foot, has never, we believe, been tried on a patient far advanced in life. It was, therefore, a matter of some interest to determine how far the malformation, in the present instance, might have admitted of remedy by surgical means. The tendons of the anterior muscles were divided, and immediately the point of the foot was brought down to a right angle, the deformity almost completely disappearing. Bul. of the Academy, Dec. 1838.. Red Sulphur Springs of Virginia. In many pulmonary affections, in which change of air, scenery, and appropriate natural waters are indicated, no situation appears to offer more advantage to the invalid than the Red Sulphur Springs of Virginia. Possessing a delightful climate, a water which, on the authority of several observers, diminishes the frequency of the pulse, and acts markedly as a sedative, and with accommodations, furnished by the enterprising proprietor, well adapted for the comfort of the valetudinarian, there is no retreat which promises more in the affections referred to, as well as in all those chronic derangements of internal organs, for which traveling air and exercise, with the various advantages above mentioned, are deemed advisable. We have lately seen the details of two serious cases which were strongly 1 Edin. Med. and Surg. Journ. April, 1839, p. 559. 2 Lancet, March 2, 1839, p. 846. |