declarations, in a late discussion at the Royal Academy of Medicine in Paris, obtained. So that, of 140 patients operated on, 28 only have been cured, and 112 have died.-Journal des Connais. Méd. Juin, 1839.1 On the Superiority of M. Reynaud's Operation for Circocele. By M. JULES ROUX, M. D.-M. Reynaud takes, with both his hands, the spermatic cord of the diseased side; he isolates and pushes inwards towards the root of the penis the vas deferens, whose hardness distinguishes it from the vessels and nerves of the testicle; pinching then the scrotum with the forefinger and thumb of the left hand, so as to embrace the spermatic vessels and nerves, he passes through the base of the fold thus formed, a curved needle, with waxed thread. The scrotum then let go, there remains, between the entrance and exit of the needle, an interval of about an inch; upon this interval is placed a thick cylinder of lint, but not very long; and the two ends of the ligature brought together over it, and tied by a bow-knot, so as to admit of untying or relaxing, should it become necessary, to diminish its pressure. Small pledgets, with cerate, are put upon the punctures: no bandage is necessary to keep them, but a simple compress is placed over all. The patient remains in bed, with the scrotum on a cushion, and is treated with diluents and lavements. A few days after, inflammation round the ligature takes place, ordinarily slight, and not preventing a tighter tie of the contained parts. If, however, the inflammation be violent, or the pain excessive, M. R. unties and slackens the ligature, reduces the inflammation, and again reties it; which occupies about two or three days' time. As the soft parts become divided, the ligature is tied again with more pressure. Towards the fifteenth or eighteeth day, the nerves and vessels of the testicle have been divided, and there remains only the skin to be cut. M. Reynaud now passes a directory in the line of the thread, and divides the skin with a bistoury. A simple wound succeeds to this incision, and quickly cicatrises; so that, in about twenty-five days from the commencement of the operation, the patient is ordinarily cured. Two cases have been successfully treated in this manner by M. Reynaud.2-Journ. des Con. Méd. No. V. Feb. 1829. Case of Difficult Delivery of Twins which were united by the Breast. By the Berg-chirurgus Rath of Zellerfeld. (From the Archiv. der Harzer Chirurgen-Verein.)—The patient was turned forty years of age; mother of several children. She had passed the first half of her pregnancy in perfect health: but during the last few weeks before labour, complained of constant cramps and much pain from the movements of the child. Shortly after the os uteri was dilated, the pains subsided; and although they were again excited by the ergot, they had no effect in forwarding the labour. The forceps was now applied, and the head brought down as far as the os 3 Ibid. p. 568. 'Brit. and For. Med. Review, Oct. 1839, p. 558. 2 Ibid. p. 559. externum, but beyond this it was impossible to move it; and on further examination, a second head was found behind the first in the pelvic cavity. The patient was much exhausted, the abdomen tympanitic, very pendulous, and acutely painful; the external parts much swollen. A prolapsed umbilical cord was felt beating at the lower and posterior part of the vagina; but the patient had not felt any movement for some time. As there was no doubt that the first child was dead, and that it was an insurmountable obstacle to the delivery of the other, which might still be alive, and also increased the patient's danger, by protracting the labour, the head was separated from the body with some difficulty, owing to the closeness with which it was embraced by the external parts. It was effected by means of a gum-lancet, which the author considers to be an excellent instrument for the purpose. The second head could now be reached with the forceps, and was brought down as far as the chin and nape of the neck; but another obstacle now showed itself: after repeated examinations it was ascertained that the children were united by the breast, and that one had its back to the pubes, the other to the sacrum. The author endeavoured to give them such a direction that they should be in the longest diameter of the pelvis, by which means he succeeded in bringing them down as far as the shoulders. Having carefully disengaged the arms, and turned the children again into the antero-posterior diameter, and having fixed a blunt hook upon the band which united them, he gave it to an assistant, and then, with a fore-finger in the axilla of each child, he completed the delivery. Considerable hemorrhage required the speedy removal of the placenta, and the uterus now contracted. The children (two girls) weighed 15 lbs.; they were 17 inches long. The part by which they were united was 9 inches long and 3 broad, and extended from the upper extremity of the sternum to the navel, into which one umbilical cord, which was common to both, entered. The diameter of the two children, when laid close together, was between 7 and 8 inches, from back to the other. One child had two thumbs on the right hand. The cord was 19 inches long, and unusually thick. After suffering some time from peritonitis, &c. the patient recovered.-Siebold's Journal. B. 17. Heft ii. 1838. Morton's Crania Americana. We are happy to announce the receipt from the author of a copy of this splendid work, to the expected appearance of which we have more than once referred. We shall notice it in our next number. BOOKS RECEIVED. From Dr. Oppenheim, of Hamburg.-Zeitschrift für die gesammte Medicin, u. s. w. Jun. Jul. August. 1839. From the same.-Jornal da Sociedade das Sciencas Medicas de Lisboa, Janeiro, Fevereero, Marco, 1837. From the same.-Relation de la Société de Médecine et d'Histoire naturelle en Moldavie, &c. lassy. From the same.-De Labio Leporino, &c. Auct. Carol. Rudolph. Caspar. Accedunt iv tabulæ ære excusæ. 4to, pp. 55. Gotting. 1837. From the Author.-The Nurse's Guide, containing a series of instructions to females who wish to engage in the important business of nursing mother and child in the lying-in chamber. By J. Warrington, M. D., Lecturer on Practical Obstetrics, Accoucheur to the Philadelphia Dispensary and Philadelphia Nurse Charity, &c. &c. 12mo, pp. 131. Philad., 1839. From the Publishers, Marsh, Capen, & Co., Boston.-The second volume of Dr. Gross's Pathological Anatomy. The first volume has not reached us. Case of Typhoid Fever. Reported by J. B. CoTTMAN, M. D., Senior Resident Physician. Margaret Morton, æt. 22; servant; born in Trenton, New Jersey, has been married five years; was confined in the obstetrical ward of this institution with her first child four years ago; enjoyed good health until the 8th of August, 1839, when she was taken with pain in her head, chest, and back; felt so weak in her knees that she could scarcely walk, (was then living at the inclined plane on the Columbia Railroad;) remained in this state until Sunday, August 11th, when she was brought to the hospital. State.-Face slightly flushed; pulse a little excited; says she has diarrhœa; no pain on pressure over abdomen. Ordered . Olei ricini, Zij. Tr. opii, gtt x. 12th. The nurse reports that she has been up only twice within the last twenty-four hours; evacuations of good consistence; pulse somewhat excited; skin warm and dry; thirst. Ordered ice internally and to the head; milk diet. 14th.-Dr. Dunglison saw her at his visit to-day; found her pulse very frequent; tongue coated with a yellow fur; skin hot and dry; bowels have been open once in the twenty-four hours for the last two days. Ordered Pulv. ipecac. grs. xv. Statim. Continue other treatment. 15th.-Medicine vomited her very freely; commenced purging at night; to-day her bowels have been open ten or fifteen times; evacuations bloody; pain on pressure over the abdomen; pulse frequent; skin hot and dry; tongue somewhat cleaner. B. Hyd. chlorid. mit. gr. i. Pulv. opii, gr. :-ter in die. 16th.-Bowels open less frequently-eight or ten times in the twenty-four hours; stools still contain some blood; other symptoms the same as yesterday. Continue treatment. 17th.-Fever very high; skin hot and dry; pulse 120, quick and irritable; cephalalgia; meteorism; anorexia; great tenderness on pressure over the epigastric region; diarrhoea still continues. B. Olei ricini, 3ij. Statim. . Mist. efferves. 3vi. Capt. 3ss. q. h. sec. Cucurbitul cruenta, No. VI. epigastrio. Ice internally and kept constantly applied to head. 19th.-Mouth affected by the calomel; gums red and swollen; face flushed; skin hot and dry; pulse 110, irritable; pain on pressure over the abdomen. Discontinue calomel and opium; commence with the following: . Pulv. ipecac. comp. grs. ij. quater in die. Continue other treatment. 8 o'clock, P. M.-Increase of cerebral symptoms; dulness of hearing; tinnitus; intellect dull; increase of fever; skin hot and dry; thirst; complains of pain in head; skin of head very hot; pulse frequent. Cucurbitula cruenta, No. VI. nucha. Felt much relief from the cups; fell asleep immediately after, and slept well all night; found her asleep at 12 o'clock next day. 21st.-Yesterday evening complained very much of pain in head, dryness of mouth, thirst; intelligence dull; rose-coloured spots very distinct over the abdomen, a few on the thorax; face flushed; skin hot and dry; pulse 120; complains of pains in abdomen, with tenderness, more especially at epigastrium. Emp. epispas. 6x6 epigastrio. Blistered surface to be dressed with the following ointment: Ung. hydrarg. fort. 3i. Apply a mustard cataplasm to lower part of abdomen. Continue Dover's powders. 22d.-Slept well; appearance rather improved; drowsy; dulness of intellect; answers questions slowly; yesterday, in an effort at vomiting, felt something "give way" in the right side of her head: since then has been very deaf in the right ear, and complains of much pain; pulse 100, regular; skin cooler; bowels open twice this morning; evacuations scanty. Continue treatment. 238.-Slept well; this morning is very dull and stupid; answers questions very imperfectly; pupils contracted; tongue coated with a brown fur; pulse 80, intermittent; action of heart irregular, remits every third beat; skin hot and dry; lost three or four ounces of blood to-day by epistaxis, with apparent relief of the cerebral symptoms; bowels have not been open to-day. Emp. epispas. 3×2 No. II. behind the ears. An enema of warm water: Continue ice. Discontinue Dover's powders. 24th.-Slept none; very restless, constantly tossing about the bed, moaning and crying aloud; face flushed; pupils contracted; intelligence dull; does not answer questions, but seems to understand; tongue cleaner; papillæ at the tip elevated. Blisters did not draw well; dressed with the ung. hydrarg. Bled freely from the nose during the night; pulse 88, intermittent in the course of an hour it rose to 120, full, though compressible; face became very much flushed; skin was hot and dry; patient delirious. Apply thirty American leeches to temples and behind the ears. Continue other treatment. 25th.-Slept none during the night-a few hours this morning; at present remains quiet; pulse frequent and full, regular; pupils contracted; tongue clean; answers no questions, and appears scarcely to comprehend them; bowels open twice to-day in the afternoon her face became very much flushed; eyes suffused; pulse more frequent; skin hot and dry. Íce was applied freely to the head, and the other treatment continued. 26th.-Slept none, constantly tossing about the bed throughout the night -has slept three hours this morning; pupils contracted; tongue dry; re spiration easy; skin warm and slightly perspirable; pulse 144, full; skin of head and feet hot; slight subsultus; delirious; voice very much altered, shrill. Cucurbitulæ cruentæ, No. IV. nuchæ. . Olei ricini, 3ij. statim. 27th.-Slept none; very delirious all night; constant jactitation; expression wild; face very much distorted, expressive of pain; does not answer questions; subsultus tendinum; skin of natural temperature; tongue dry, covered with small ulcerations about the tip; complete anorexia; pulse 120, compressible; diarrhoea slight; three evacuations in twenty-four hours, containing shreds, very offensive. . Ol. terebinth. 3ss. Muc. lini. 3vss. pro enemate. Ice to be kept constantly applied to the head; mustard cataplasms to abdomen and legs; blistered surfaces to be dressed with the ung. hydrarg. 28th.-Slept five hours; very much improved; expression better; more intelligent; asks for food; answers questions; very deaf; no subsultus; tongue moist, tip diphtheritic; respiration easy; slight cough; temperature of skin natural; pulse 102, regular; epistaxis during the night; four stools in twenty-four hours, yellow, contain no shreds, less offensive; had two stimulating injections last night-one to-day. Continue treatment. 29th.-Slept well last night; improved in every respect to-day. Continue treatment. 31st.-Slept well on the night of the 29th, with manifest improvement the next day; slept very little last night; slightly delirious to-day; still very deaf; tongue moist, cleaner, no ulcerations; slight bronchitis; some cough; less tenderness on pressure over region of abdomen; bowels open three times in twenty-four hours, consistence good, natural. Continue ice internally, and a common injection instead of the stimulating one; discontinue cold applications to head; gruel. September 1st.-Slept well until about 4 o'clock this morning, then became wakeful, and tossed about the bed; moaned much; slightly delirious to-day; skin hot and dry; the rose-coloured spots have entirely disappeared from the abdomen and chest, and been replaced by numerous sudamina. Ice to head. Continue other treatment. 2d. Sleep disturbed during the night-has slept, however, some to-day; expression rather wild; eyes very prominent; skin warm; pulse 100; bowels open once in twenty-four hours. Continue treatment. 3d.-Slept well; improved; skin natural; pulse 100, regular. Treatment the same. 6th.-Patient has been doing well since last date. Convalescent; allowed ice internally, and a better diet; discontinue all other remedies. 10th. Still improving; sudamina have almost entirely disappeared; spleen felt very distinctly; tongue clean; bowels kept open once in the twenty-four hours by means of small doses of castor oil. 15th.-Patient able to sit up; hears much better; appearance much improved; appetite good; allowed a mild and unstimulating diet. Oct. 2d.-Quite well. Discharged cured. This case is interesting, as it presented all the symptoms of typhoid fever so well marked; not only those phenomena which have always been ranked with the symptoms of fever, such as the temperature, state of the tongue and pulse, but those which have more recently been considered to mark a peculiar form of fever, namely, meteorism, rose spots on the abdomen, sudamina and enlargement of the spleen. |