adaptation is required." Many of the author's views are connected, however, with the existence of this power of adaptation.

Dr. Wallace has evidently bestowed much attention on the eye in its healthy and diseased state, and-we doubt not-is a skilful oculist.

MISCELLANEOUS NOTICES.

Washington University, Baltimore.-The Washington Medical College has, by a late act of the general Assembly of Maryland, been converted into a University, with the powers attached to such Institutions. We observe, also, that the Government of the United States has selected the Hospital attached to the University as the place in which the seamen of the port of Baltimore, entitled to Hospital relief, are to be received.

The number of students, during the last season, was fifty-three; of graduates seventeen.

Haynes's Utero-abdominal Truss-We have been favoured by the contriver with one of these ingenious instruments, which resemble the "uteroabdominal supporter" of Hull. A great difference however, is in the coiled springs, which are concealed in the pads, and attached to the body and perineal straps. They are designed to allow of freedom of motion in the patient, whilst, at the same time, they aid in supporting the parts in whatever position she may place herself.

The instrument impresses us favourably, and we should like to see its merits well tested.

Clinical Remarks by SIR B. C. BRODIE. Operations.-When I was a young hospital surgeon, I entertained a very exalted idea of operative surgery, and thought very highly of the great importance of immediately performing an operation whenever it might seem to be required. I have had much experience, however, since that time, and I now think that some little circumspection should be used beforehand, and that the chances of recovery which you give to the patient by immediately operating should be well weighed, giving notice to the patient of any danger that may occur from such speedy proceeding with the knife, as well as the results that may arise to him afterwards, even on recovery. More particularly should this injunction be observed in operations upon patients in whom scrofulous and carcinomatous temperaments are evident. You may say to me that in these latter cases the patient would die if a cancerous breast were not removed, and that the operation per se would not make the patient worse. That may be true, but you must remember that some harm would certainly ensue were it only from increasing the pain which the patient has already borne so long. But there is a much greater mischief than this. You should consider well what the effect of an unsuccessful operation will be upon the minds of society at large, for every surgical operation that fails, prevents two or three persons from submitting, in cases where the use of the knife might be successful. This caution is required at once on behalf of ourselves, of society, and of our art. Do not, then, always operate when you will by no means be sure of success, and when you are sure that the operation will fail, even if the patient wishes it ever so much. Unfortunately, surgeons in general are not observant of such a line of conduct as this. You can, of course, lay down no general rule: each case will require a separate consideration; but this much is certain, that patients with organic diseases are always bad subjects Rudiments of Physiology, P. iii. p. 48. Edinburgh, 1837. 2 London Lancet, Aug. 17, 1839, p. 743.

for the knife. If one comes to you with a diseased knee, and you discover that he has some visceral affection, do not operate upon him, for if you do the stump will slough, and the patient die. If in a patient with stone you discover that the bladder or the kidney is diseased, (I do not mean functionally), hold your hand, or depend on it he will die in three or four weeks. Be equally careful in all truly malignant diseases, as well as in all varieties of what are called half malignant diseases. Surgeons were formerly very ready to operate in all cases, but I do not operate in one case out of sixty that I see. All persons who wish to become the subjects of operations come to London to have them performed. In very many of these cases I have known the operation to fail. I have objected to it myself, and it has been done fatally by another surgeon. Where malignant disease is combined with disordered visceral action, there is a very great probability of the disease afterwards returning. Not that you are to refuse to operate in all such cases, for in some of them you may prolong the patient's life, with a great respite from suffering. A patient had better die of diseased lungs than of cancer. But in these cases be very careful what you do. Small operations constitute the best part of operative surgery. They reflect most credit on the profession, and do more good to society. What good do they effect? Why how many cases are wholly cured by small operations! And, moreover, they are not dangerous. But small operations may bring on erysipelas; therefore be careful not to operate when erysipelas is prevalent. And at all times enquire into the state of the general health. Learn if the patient be a drunkard or a free liver; and if so, beware. I knew a lady of fashion who got drunk every morning, and died from the puncture of a small encysted tumour. Women of high rank are very nervous and hysterical. Persons in whose families mania may have existed, are bad subjects for operations. They sometimes die afterwards in a very strange mannerwith some very unusual symptoms.

Strictures.-Any foreign substance in the bladder, such as red sand, or ropy mucus, will, by its presence, irritate the neck of the bladder and parts immediately adjacent, and impede very much the progress of cure in stricture. First get rid of the abnormal visceral secretion, and then proceed with proper remedies to cure the stricture.

Encysted Hydrocele.-A little boy, about four years of age, was admitted under my care, with a tumour occupying the right side of the scrotum. On its first appearance it resembled hernia, but on further examination I found it to be an encysted hydrocele of the chord. It could be pressed up behind the tendon of the external oblique muscle, and when there it could very easily be felt. I have met with several similar cases. The great diagnostic mark between it and hernia is that you feel a substance of intestine over the chord, which you would not do if the disease were hernia, whilst the tumour in the scrotum is perceptible to the touch. The child was ordered to have the tumour covered with a solution of muriate of ammouia, in the proportion of one dram to four ounces of water, and four ounces of acetic acid.

BOOKS RECEIVED.

From the Author.-Observations on the Typhoid Fever of New England. Read at the Annual Meeting of the Massachusetts Medical Society, May 29th, 1839. By Enoch Hale, M. D. attending physician to the Massachusetts General Hospital. 8vo. pp. 77. Boston, 1839.

From the Publishers, Messrs. Haswell, Barrington & Haswell.-Medical and Topographical Observations upon the Mediterranean; and upon Portugal, Spain, and other countries. By G. R. B. Horner, M. D. U. S. N., Surgeon to the U. S. Naval Asylum, and Honorary Member of the Philadelphia Medical Society, with engravings, (lithographs). 8vo. pp. 212. Philadelphia, 1839.

Annual Circular of the Washington University of Baltimore, Medical Department, July 1839. 8vo. pp. 18. Baltimore, 1839.

THE

AMERICAN MEDICAL INTELLIGENCER.

Vol. III.

October 1, 1839.

No. 13.

For the American Medical Intelligencer.

ART. I.-PHILADELPHIA HOSPITAL, (BLOCKLEY.)

DR. DUNGLISON, ATTENDING PHYSICIAN.

Case of Apoplexy-Extensive softening of the left corpus striatum. Reported by JOSEPH B. COTTMAN, M. D., Resident Physician.

George Freeborn, æt. 21, labourer; born in Ireland; came to this country about four weeks ago; landed in New York; was then in perfect health; came to Philadelphia soon afterwards; was much exposed to the sun during his passage over, and for several weeks since he has been in this country; attacked with vomiting and intense pain in his head on the 15th of July; a physician was called to see him, who had his head shaved; cups, leeches, and blisters were applied to the nape of his neck, blisters to the lower extremities, and he took some medicine internally; he gradually grew worse until the 3d of August, when he was deprived of speech; on the 4th, rigidity of right arm and leg was observed, which continued to grow worse until the 9th, when he was brought to the hospital.

State. Very much emaciated; decubitus dorsal; left leg slightly flexed; right side completely paralysed; extremities very rigid; skin warm and moist; pulse 120 in right armi, and scarcely perceptible in left; face flushed, distorted; mouth drawn to left side; pupils dilated; nostrils dilate very much on expiration; tongue coated with a dark brown fur; gums and teeth covered with sordes; respiration laboured, costal; a wheezing noise in breathing; takes no notice of any thing; has to be confined to his bed by means of straps to prevent him from falling out.

Treatment.-Blisters were applied to the nape of the neck and to the

extremities.

August 10th, A. M. Slept none; restless during the night; this morning is improved in appearance; observes objects; pupils not so much dilated; skin warm and perspirable; pulse 120 in right arm; passes his evacuations, which are thin, watery, and yellowish, in bed.

P. M. Very restless; face very much distorted, and expressive of pain; lies on his back, with his left hand constantly applied to his head; the right hand lies powerless by his side; arm and leg on right side very rigid; loss of sensation; temperature of right side, as indicated by a thermometer placed in axilla, 990, left side 104°; subsultus tendinum in both extremities; skin of left side natural temperature, and perspiring; pulse 126 in right arm, full and bounding; blister drew well. It was ordered to be dressed with the ung. hyd. fort.; blistered surfaces on extremities discharge freely; dressed with the same. Applicentur hirud. American. No. xxxvi ad tempora. 11th A. M. Slept none through the night; found him asleep at the morning visit.

P. M. Intelligence clearer; observes when spoken to; endeavours to protrude his tongue when asked to do so; tongue still coated with a dark fur; teeth covered with sordes; pupils slightly dilated; respiration easy; pulse 112, full and regular. Continue the mercurial dressings, and give the following enema every night.

B. Ol. terebinth. 3ss. muc. lini 3vss.

12th P. M. Expression calm; face not so flushed; skin of left side of natural temperature; respiration easy; pulse of right arm 98, regular, scarcely felt in left; drowsy; slept a greater part of the day; asleep at present; intelligence at times better; recognised some acquaintances who came to see him to day.

Continue to dress the blistered surfaces with the unguentum hydrargyri, and give the stimulating injection at night.

13th A. M. Slept very little during the night; very noisy; constantly moaning; pupils somewhat dilated; mouth drawn more to left side; extremities of right side more rigid; passes his evacuations involuntarily. Continue the

treatment.

14th. No change since yesterday. Continue the treatment.

17th. Somewhat improved; expression better; stronger; is able to raise himself in bed by the aid of his left arm alone; pupils slightly dilated; mouth still drawn to left side; tongue cleaner; gums very much swollen; mercurial fœtor of breath; teeth covered with sordes; respiration easy; pulse 98, regular; passes his evacuations in bed.

No change in the treatment since last note; apply another blister to the nape of neck; blisters on lower extremities still open, dressed with the unguentum hydrargyri.

21st. More intelligent; observes when spoken to; extends his left hand when asked to do so; expression improved ; pupils more natural; tongue and gums clean; pulse 120 on right side; right arm and leg still very rigid; very noisy at night; moans almost constantly; sat up yesterday in an arm chair a greater part of the day, a strap being put around him to prevent him from falling out. Continuent. remedia.

22d. Improved ; allowed to sit up during the day.

23d. Became faint yesterday afternoon; very drowsy; could not be aroused; pulse failed; extremities became very cold; means were made use of which brought about slight reaction; he, however, soon sank back into the same state, and died August 25th.

Necroscopy ten hours after death.-Exterior very much emaciated; on dividing the scalp and dissecting it off, two marks of contusions were observed on the parietal bones on each side.

Brain.-Dura mater natural, slightly adherent to arachnoid; a few vessels were detached on separating it; arachnoid injected and slightly opaque on the summit of both hemispheres, more particularly the left; no fluid in the longitudinal sinus; about a gill of fluid between the membranes and the brain, immediately anterior to the medulla oblongata ; on cutting down into the right ventricle, a small quantity of fluid was found-about two drams; substance of brain, on the right, natural; the substance of the corpus striatum on the left side, in its upper portion, to the extent of about one fourth of an inch, was reduced, to a greenish yellow pulpy mass; portions of it were reduced to a yellowish pus; the medullary substance of the brain on that side, as far up as the base of the convolutions, was softened, to the extent of two and a half inches in the antero-posterior direction, and two inches in the transverse, extending more particularly to the anterior portion of the brain; choroid plexus very finely injected; the arachnoid membrane, extending over the base of the cerebellum, was more than ordinarily injected; over the pons varolii and about the medulla oblongata very minutely injected; substance of the cerebellum of good consistence; of the medulla oblongata also. The other organs of the body were normal, with the exception of the kidneys, which were atrophied J. B. COTTMAN.

ART. II.-CLINICAL OBSERVATIONS ON THE USE OF THE AIR-DOUCHE IN THE DIAGNOSIS AND TREATMENT OF DISEASES OF THE EAR.

BY T. WHARTON JONES, ESQ.'

Circumstances having of late forcibly drawn the attention of the profession to catheterism of the Eustachian tube, and injections of atmospherical air into the tympanum, it behoves every one to contribute what mite of information he may possess, at all calculated to clear away the difficulties or doubts which hang about the subject; for, like most new modes of treatment, considerable misconception prevails regarding it, both as to the principle and performance of the operation, as well as its advantages, being on the one hand overrated, and on the other underrated.

Carefully observed and faithfully reported cases, it is obvious, are the only means of guiding to a correct judgment. Many cases are to be found in the works of Deleau and Kramer, but they do not record the daily progress of the treatment: for this reason I have thought the following cases, extracted nearly word for word as they occur in my case-book, might be read not without interest. And here I would express a hope that these contributions will be received as they are offered, viz. as imperfect observations on a subject not, indeed, of easy investigation, but by no means incapable of it— a subject, which, it is hoped, surgeons will see the propriety of attending to more than hitherto, so as to be able to discriminate what can from what cannot be done, and what it is safe from what it is unsafe to do. In all this we must keep in mind the precept-"Nil fingendum, nil excogitandum, sed inveniendum quod natura ferat-quod natura faciat."

It is to be premised, that we endeavour to form our diagnosis of the state of the Eustachian tube and cavity of the tympanum on the principle already adopted in diseases of the chest, viz. to hear when it is impossible to see or touch the disease, the only difference being, that the air producing the sounds in the tympanum is put into motion artificially by the air-douche.

In regard to the air-douche as a means of treatment, all that can be effected by it is the gradual dispersion of any accumulation of mucus which may exist in the middle ear, or the rendering pervious the Eustachian tube, the walls of which have been glued together by thickened mucus.

The eye and ear, though apparently so very different from each other, coincide in many respects both in their structure and in their diseases. As the diseases of the former are much better known than those of the latter, the cautious use of this analogy will be of material service in our examination of the morbid conditions of the ear. Thus, for the sake of example, it may be mentioned that the conjunctiva, that part of the eye which is the seat of some of its most important diseases, is a mucous membrane situated at the peripheral surface of the eyeball. In the ear some of the most common cases of the derangement of its function depend, in like manner, on the morbid condition of a mucous membrane-that lining the cavity of the tympanum-which, being situated at the peripheral surface of the labyrinth, the essential part of the apparatus of hearing, bears exactly the same anatomical relation to it as the conjunctiva does to the eyeball. Again, the nasal duct, a mucous canal, is the seat of some not unfrequent and very troublesome affections of the eye. The Eustachian tube, which resembles the nasal duct in every anatomical particular, does so also in a remarkable degree in its pathological states. Many more examples might be given of the similarity between the structure and diseases of the eye and ear, but these are sufficient to direct attention to the fact. It is to be borne in mind, however, that in consequence of the difference of conditions required for the exercise of the functions of the two organs, the same elementary form of disease shall have a very different effect on vision and hearing. For ex

1 Lond. Med. Gaz, Aug. 3, 1839, P. 670.