Restoration of a Large Portion of the Face.'-The following case presents an example of one of the most fortunate attempts which, perhaps, has ever been made to restore, by surgical operation, a large portion of the human figure:

A Belgian soldier received, in 1831, a gun-shot wound, which shattered the lower jaw, cut through the tongue, and carried away the upper lip, with the cheek and superior maxilla. The mouth and nasal fosse were thus converted into one cavity; behind the velum pendulum and palatine bones were untouched, but the mouth communicated on either side with the zygomatic fossæ. On the right side the floor of the orbit was driven in, and the eyeball forced out of its cavity. This enormous wound did not bleed, and the man was carried off the field three hours after its receipt. A long time elapsed before any regular surgical aid could be afforded, when the face presented the most deplorable appearance. The portion of the nose which remained had become adherent to the roof of the palate; the fragments of the lip and right cheek were rolled up and useless; the perpendicular diameter of the face was much reduced by the loss of the upper jaw-bone, while the lower maxilla was carried upwards and touched the dorsum of the nose. The tongue was adherent to the roof of the mouth, and the patient could only express himself by indistinct guttural sounds.

On the 18th of March, 1839, M. Burgraeve endeavoured to correct these deformities by the following operation:-The lower lip was separated on either side by two cuts with the scissars; two other incisions were then made (the convexity being downwards) from the opening of the nasal fossæ to the anterior edges of the maxillary bones, while two incisions descended at right angles to the last, along the masseter muscles to the angles of the lower jaw. Two flaps were thus formed, and separated from the subjacent parts, being adherent to the skin of the neck by two pedicles of an inch in breadth. The nose was now dissected away from its adherences to the palate, and two side-flaps brought together, the nose being placed on their juncture at the middle line of the new lip. The upper and internal angle of the right flap was fixed by two points of suture under the angle of the right orbit, and the other portions of the edges were also united by points of the interrupted suture. This tedious and terrible dissection lasted an hour and a quarter. No dressings, save lint and water, were applied; the patient took an opiate draught. The cold lotions were continued. On the third day it was found necessary to remove a silver plate which had been placed under the flap to represent the maxillary bone and dorsum of the nose. As the mouth was too narrow to permit its extraction, M. Burgraeve divided the sutures along the median line of the wound, and extracted the metal plate without difficulty. On the healing of the different parts of the wound it was found that the lower jaw still ascended above the upper lip, and rendered the ingestion of food difficult. To remedy this defect the surgeon elevated the commissures of the mouth on either side by removing elliptical portions of the skin, in the direction of the naso-labial lines, and this had the desired effect; he also cut away the indurated cellular tissue of the cheek, which had been occasioned by the dissection of the flaps.-French Medical Gazette, Sept. 31, 1839.

Population of France. The total number of births in Paris during the year 1837, was 29, 192; or, 14,651 boys and 14,541 girls. Of the number born, no less than 9,578, or nearly one third, were born out of wedlock, The number of deaths amounted to 28,134. There died-at home, 17,127 persons; in hospital, 10,604; in prison, 99; while 304 bodies were deposited at the Morgue.

London Lancet, Oct. 12, 1839, p. 102.

Ibid. Oct. 5, 1839,

p.

71.

Hence of every five persons who die in Paris only three have the satisfaction of dying in bed.

The number of deaths from small-pox, out of a population of 774,338, amounted to 458; in the year 1936, it was only 227.

The proportion of males to females born is as 17 to 16; but of children born out of wedlock, the proportion is as 24 to 23.

As there is one birth for every 32.7 inhabitants, if we suppose the population to remain nearly stationary, the mean duration of life is expressed by 32.7 years. Before the revolution, it was only 28.75.-French Lancet, Sept. 10, 1839.

Prison Mortality in France.'-From 1315 to 1818, the general mortality of the prisons in Paris was one death for every 12.01 prisoners; from 1819 to 1825, the mortality was reduced to 1 in 15.30. In the other prisons of the kingdom the general mortality was 1 in 20.9.

In the places where galley slaves are confined, the mortality from 1816 to 1827 was as follows:

From the Publisher.-Plates of the Arteries, with references; for the use of Medical Students. By Paul B. Goddard, M. D., Demonstrator of Anatomy in the University of Pennsylvania, &c. &c. 4to, pp. 49. 12 lithographic plates. Philad. 1839.

From Dr. John H. Dix.-The Boston Medical Journal for Sept. 25, 1839; containing his communication on Deafness relieved by Injections of water through the Eustachian Tubes.

From the American Editor and Publishers.-The London Dissector, or Guide to Anatomy, for the Use of Students; comprising a description of the muscles, vessels, nerves, lymphatics, and viscera of the human body, as they appear on dissection; with directions for their demonstration. From the first American edition. Revised and corrected by Edward J. Chaisty, M. D., Demonstrator of Anatomy in the University of Maryland. 12mo, pp. 273. Baltimore, 1839.

From Messrs. Lea & Blanchard, the Publishers.-New Remedies: the Method of Preparing and Administering them; their Effects on the Healthy and Diseased Economy, &c. &c. (Prodesse quam conspici.) By Robley Dunglison, M. D., M. A. P. S., Professor of the Institutes of Medicine and Materia Medica in Jefferson Medical College of Philadelphia, Attending Physician to the Philadelphia Hospital, &c. &c. 8vo, pp. 503. Philadelphia, 1839.

From the Translator-Anatomical, Pathological and Therapeutic Researches on the Yellow Fever of Gibraltar, of 1829. By P. Ch. A. Louis, Physician to the Hotel-Dieu, President for life of the Society for Medical Observation of Paris, Member of the Royal Academy of Medicine of Paris, Honorary Member of the Massachusetts Medical Society, &c. &c. From Observations taken by himself and M. Trousseau, as Members of the French Commission at Gibraltar. Translated from the manuscript by G. Shattuck, Jr., M. D., Member of the Society for Medical Observation at Paris, Fellow of the Massachusetts Medical Society. 8vo, pp. 374. Boston,

1839.

From the Author.-A Table of Chemical Equivalents, arranged for chemists and pharmaceutists. By James Hamilton, M. D. Baltimore. (One large sheet.)

1 London Lancet, Oct. 5, 1839, p. 71.

ART. I.-CASE OF EXTREME SENSIBILITY OF THE RETINA.

Professor Dunglison.

BY JAMES W. SALTER, M. D.

Richmond, Ia., Nov. 16th, 1839.

Dear sir, I herein take the liberty of sending you a report of a case of extreme morbid sensibility of the retina, possessing, I think, some interest. If you should deem it worthy of a place in the Medical Intelligencer," please give it an insertion. As the case proved a stumbling-block" to some who had been long in practice, perhaps its publicity may be of use to others.

Very respectfully, your obed't. servant,

JAMES W. SALTER, M. D.

The subject of the following case was a daughter of Mr. M. K., residing in this vicinity, æt. 3. She was attacked about eight months ago with violent inflammation of both of the eyes, which was partially subdued by an antiphlogistic course of treatment. Several states of relapse and partial alleviation occurred during the first three or four months. The eyes then became permanently so irritable as not to admit a particle of light, which state continued until the case was dispaired of, and finally given up by a respectable practitioner as incurable. On the 1st of October, and about six months after the first attack, I was requested to see her. I found the little patient lying upon her face, which position she obstinately maintained both day and night, with the eyelids much swollen and some abrasions about the nose and forehead, produced by the constant pressure and friction; pulse quicker and more frequent than natural; tongue slightly coated; bowels regular; appetite tolerable; and the mind excessively irascible, not bearing the least attention. All my attempts to examine the state and appearance of the balls of the eyes were rendered perfectly fruitless, partly by the swollen state of the lids and partly by the excessive suffusion of tears whenever the attempt was made. My pathological deductions were, that this was no longer an inflammatory disease, but purely a morbid sensibility of the retina. superinduced by the previous inflammatory action, and kept up by the entire exclusion of light. I prescribed sulph. quinæ, elix. vit. and tr. opii comp. in combination as freely as the stomach would bear, and ordered a more generous and nutritive diet. In less than three weeks' time I had the satisfaction of seeing the use of my little patient's eyes entirely restored-the only vestige of disease being a small opaque spot upon the cornea of the left eye, which is gradually being absorbed.

JAMES W. Salter.

ART. II.-CASES OF THORACIC DISEASE.

Dr. Dunglison.

Por the American Medical Intelligencer.

Dear sir,-I send you abstracts of my notes of two interesting cases of thoracic disease, which you are at liberty to publish-all, or as much as you may think proper. Yours respectfully,

JAMES M. GREEN.

Case of T. L. S., in his fortieth year. A man of sanguine temperament and active habits, formerly of athletic frame, has been much exposed in various climates for twenty years. Has suffered from bronchial affections coughs, colds, difficulty of breathing, &c., for sixteen years, increasing in violence and frequency, and lately accompanied by disordered action of the heart.

Present state, Nov. 5, 1838.-Great fatigue and violent palpitation on ascending a flight of steps; distressing cough, and plentiful muco-purulent expectoration every morning on awakening; stomach disordered in its functions; anorexia; bad digestion, &c. Liver and spleen both enlarged and sore to the touch. Heart apparently dilated, and laborious in its action, impulse feeble, but distinct in both hypochondria and in the epigastrium. Sound on percussion on left side very clear from spine behind to sternum in front. On the right side in front relatively flat above and more so about the mammary region; same characters in lateral regions, but not so distinct; flatter on the right side behind than on the left. Stethoscopic examination :-sound of the heart, loud all over the lower and front part of thorax, in the right and left hypochondria and epigastrium. No respiratory sound on the right side, with the exception of an obscure vesicular respiratory murmur below the clavicle, and at the internal edge of the right scapula. Left side, in front or in the lateral regions the respiration somewhat puerile, with an occasional sonorous rattle; posteriorly there is a loud tracheal blowing sound, about as wide as two fingers, and extending from the middle of the scapula in a straight line to eighth rib, where it disappears; it is attended with loud resonance of the voice, and is distinctly defined at its margins. For several months he made a persevering use of various means of counter-irritation, including a seton on the upper part of the sternum, together with a long-continued purging with aloes, myrrh, and sulph. ferr. pills, and other modes of local and general treatment. Under the use of these remedies, and a more prudent indulgence and exposure, his face assumed its natural hue-the liver and spleen their natural size and functions, and his abdomen, from being full and prominent became flat and even depressed; appetite and digestion quite healthy.

The stethoscopic changes, noticed during many successive observations, were a gradual increase in the roughness and puerility of the respiration, until it became intensely puerile; this change seemed to take place behind, and advanced to the front of the chest, until it included the whole of the left lung; and there seemed to be a marked diminution in the apparent volume of the heart-it seemed to contract itself behind the sternum.

Aug. 16, 1839. Present state.-Abdomen flat; liver, spleen and stomach natural. A slight sound of inspiration and expiration under the right clavicle, and a blowing sound at the lower angle of right scapula; not the slightest indication of the entrance of air into any other part of right lung. The heart has changed its location entirely; it is now, as indicated by the dulness on percussion, the impulse to the hand, and the sounds to the ear, in the right inferior thoracic region. The line of pulsation and sound is considerably to the right of the zyphoid cartilage; pulsation is no longer evident in the epigastrium: with respect to size and sound the heart seems natural. Left side: the respiration is loud, rough, and puerile, except in

two places; behind, near the spine, the loud tracheal blowing still exists, and in front, from the clavicle to the third rib, it is almost natural; but the greatest peculiarity is the vast extent occupied by the lung; the loud, rough, puerile respiration extends from the spine behind to a line an inch to the right of the middle line of the sternum, and down to the very lowest false rib below. Percussion very clear at all these points, and no cardiac impulse or sound evident on the left side at all. Every morning, he has a long and difficult paroxysm of coughing and expectoration, and spends the rest of the day quite comfortably. Sept. 5th.-Was suddenly called to see him and found him labouring under severe pleuritic pain in his right side, and intense dyspnoea, very bad cough, and tumultuous action of the heart; bled sixteen ounces, and other necessary treatment. 6th.-Says he breathes with more freedom than he has done in five years: on the application of the stethoscope this morning I was surprised and pleased to observe that the air entered freely into the right lung; distinct and clear respiratory murmur all over the right side of chest not occupied by the heart; a considerable crepitus about and behind the mammary region, attended with some dulness. At sunset had another severe attack of dyspnoea; found crepitus had extended, and some bronchial râles above. 7th.-Rested tolerably and breathes freely, although there is some cough, and the dulness, crepitus, and bronchial râles are still ascending; twelve leeches above right nipple and seven in the supra-sternal fossa. 8th.-Seemed to be improving every way. 9th.-Rested badly last night, had great trouble about his heart; says he felt as if he had a parcel of stones rumbling together in his chest; applied two blisters, 5 in. long 3 wide, one to right side, and one to epigastrium: from the 10th to the 17th the inflammation continued to ascend until it nearly reached the clavicle, accompanied by crepitus, bronchial râles, and dulness; had prune juice expectoration two days, although he was leeched on the 11th and 12th, and on the 13th two more blisters to upper part of sternum and below right mamma. On the 17th the respiration was entirely tracheal below third rib, and percussion perfectly flat; blister over pectoral muscle; directed porter, and a preparation of infusion of senega, tinct. scill., carb. ammon., and tinct. op. camph. 18th.-Dressed blisters with mercurial ungt. and ordered blue pill 5 gr., calom. 1 gr., op. gr., every three hours until ptyalism was produced. 19th.-Considerable expectoration of muco-purulent matter and great relief; loose bronchial râles all over right side of thorax; applied seven leeches; from this time the hepatisation was gradually resolved; the dulness gave way from above downwards.

On the 23d, 4th, 5th, and 6th, very much prostrated by drenching perspirations. 27th.-Had a severe attack of hemorrhoids, preceded by severe constitutional irritation, but ultimately producing a natural and very beneficial derivation. State on the 30th.-Countenance bright and natural; pulse soft and regular; tongue not furred; appetite good.

Physical examination.-Some bronchophony still remaining, above and outside of right mamma, with flatness on percussion; respiration distinctly heard, dextrad to the heart; respiratory murmur pretty natural from clavicle to below fifth rib. Heart seems to be about its natural size, and decidedly more in the middle of the thorax; impulse can be felt, and sounds heard to the left of the zyphoid cartilage; the left lung has apparently retired an inch to the left of the middle of the sternum, and I think does not extend so far down among the false ribs, and the respiratory murmur is much less rough and puerile. 26th Oct.-Very much in the old state, feeble, bad cough, dyspnoea, free expectoration. Respiration obscure below the scapula on the right side behind; some tracheal blowing to the left of spine. In front, and on the right side, percussion is resonant from clavicle to between sixth and seventh ribs, where it is dull; below this is the heart lying obliquely, it would seem, with the great vessels ascending towards the articulation of the fourth rib and sternum. Some bronchophony still remaining under seventh rib below mamma, and the clear resonance still extends from