to be able to nurse; and finally it made a complete recovery. It was now about two years old, strong and healthy.

SEPTEMBER 24, 1868.

Acute Hydrocephalus.-Infant boy of Mary S., born August 16, 1868. Labor natural. Child apparently healthy. Nothing abnormal manifested itself until the sixth day, when the mother noticed that the baby's head began to grow larger. Since then it has steadily increased in size. The child's bowels were at first confined, but are now regular. It at first passed very little urine. Iodide of potassium, two grains three times a day, was given with the hope of carrying off the fluid in the cranial cavity, but proved unsuccessful, although the amount of urine excreted was much increased. Oil of juniper was then given by inhalation, half a drachm three times a day in a teacup of boiling water. Under this treatment the fluid appeared to subside, but soon increased as before. Today, the circular measurement of the head is 19 inches, the bi-parietal 10 inches, and the occipito-mental 184 inches. The sagittal suture is from an inch to an inch and a half wide, the coronal half an inch wide. The anterior fontanelle extends down to the origin of the nose; the posterior is well marked, extends to the base of the cranium, and is an inch and a half by two and a half or three inches in dimensions. This child has had no convulsions, cries little, sleeps much, and nurses well, the most marked evidence of its disease being the appearance of the head. The mother is perfectly healthy, and presents no signs of scrofula or tuberculosis.

other forms, which depended upon vices of conformation
or intra-cranial diseases. In spite of the gravity of the
affection, it was always well to attempt to save life in
any case. The treatment he had been led to believe
the most efficacious was, in addition to securing good
nutrition and perfect hygiene, the use of diuretics and
absorbents, such as squill, digitalis, nitrate of potassa
or iodide of potassium, especially the last, in two grain
doses three times a day, the dose to be increased every
second or third day till a decided impression was made,
short of gastric irritation or other contra-indicating
effect. In the present instance, he should follow this
treatment, pushing the remedy, if necessary, till two
grains were given every hour during the day. In
cases where he had been unable to obtain diuresis by
these remedies, he had produced rapid and profuse
diuresis by inhalations of the vapors of the oil of juniper,
administered half a drachm to a drachm in a teacup of
hot water two or three times a day. In this case, the
effect of this remedy had not been marked as yet.
The external application of the compound iodine oint-
ment had also been employed in some cases.
The surgical treatment of hydrocephalus consisted in
strapping the head uniformly, so as to maintain equable
pressure; tapping had been recommended by some
authors. Dr. Barker had never seen the latter resorted
to with good results. One author stated that two out
of every seven cases did well under it, but this was
contrary to Dr. Barker's general experience, and those
infants upon which he had seen it tried, died speedily.
The evacuation of the fluid was merely a palliative, the
fluid rapidly re-accumulating. Nor had he seen any
better results from strapping. He had never tried it in
his own practice; in the cases he had seen subjected to
this treatment, convulsions ensued. He was, therefore,
led to place more confidence in the diuretic and altera-
tive treatment above stated. As an instance of its
efficacy, he mentioned the case of a child who took
iodide of potassium constantly till his third or fourth
year. During this period he had more than one hundred
convulsions, sometimes as many as eight or ten in one
day, and yet he recovered after his fourth year. At
fifteen, he was nearly the same as other children in
general physical and mental development, and he is now
a promising young man in his twenty-seventh year.

HOSPITAL MEDICAL COLLEGE.

After explaining the formation of the fontanelles, Dr. Barker remarked that the posterior fontanelle was rarely, if ever, found in healthy children. Hydrocephalus occurred in two forms, the acute and the chronic. In the acute form it might be either symptomatic or essential; symptomatic, when dependent upon disease of the cerebral meninges, or of the encephalon, or upon intracranial tuberculosis. Acute essential hydrocephalus, i. e., rapid intra-cranial effusion, not consequent upon disease of the encephalon or upon its meninges or tuberculosis, was rare; yet cases had been recorded by Breschet, Aran, Andral, Trousseau, and others. But ordinarily acute essential hydrocephalus was consequent upon some other disease, especially scarlatina, and next in order of frequency, upon measles, and pneumonia. Chronic hydrocephalus was generally congenital, i. e., SURGICAL CLINIC OF ALEX. B. MOTT, M.D., PROF. BELLEVUE it was developed during foetal life, and was very rarely acquired after birth. Hydrocephalus was frequently a cause of difficult labor, necessitating the forceps or craniotomy. If the child were born alive, effusion was apt to occur rapidly. At present the cause of this disease was unknown. Some women seemed to have a tendency to give birth to children thus affected. In one case in his own practice, a woman having Bright's disease of the kidneys, gave birth to five hydrocephalic children, all still-born. Moral emotions, injuries to the mother during pregnancy, and deficient nutrition of the foetus, were supposed to stand in a causative relation to the disease. It was also affirmed to be proportionally more common in unmarried women from moral causes; but, in reply to this, the effect of tight-lacing to conceal pregnancy had been urged as an adequate physical cause to account for the occurrence of the disease in such cases. Habitual drunkenness of the father was still another condition thought to have a bearing upon the etiology.

Hydrocephalus was almost always fatal, yet occasionally cases recovered. Dr. Barker had had two recoveries in his own practice. Acute essential hydrocephalus was more apt to end in recovery than the

SEPTEMBER 19, 1868. CASE I.-Necrosis of Lower Jaw: Operation.-A middle-aged man, a worker in soda and potash, had had the first lower molar of the left side extracted nine weeks before. At the time considerable pain was felt, which, on the second day, became so intense that he had to suspend labor. The face swelled and the eye closed on the affected side. Three weeks later pus was discharged from the mouth, and afterwards from external openings, which formed over the body of the jawbone and on the left side of the neck. The probe, introduced into these openings, touched dead bone.

Operation.-Chloroform administered, followed by ether. Dr. Mott made a curved incision, about two inches in length, along the base of the jaw, through the most anterior sinus, dividing the facial artery and avoiding the vein. Both ends of the artery were ligated, which Dr. Mott strongly recommended doing whenever this artery was severed. After dissecting up the periosteum, he removed a small plate of dead bone, the size of the thumb-nail, and afterwards two larger pieces, each about half an inch by two inches. One of these

extended from the articulation to the angle of the jaw, and in most of its extent through the entire thickness of the bone. The sinus in the neck, which was quite superficial, was freely opened. There was some oozing from the incision over the jaw, so that it was temporarily left open, and pressure applied by means of sponges, It would not be completely closed, since it must heal from the bottom by granulation.

Dr. M. declared this the most rapid case of extensive disease of this bone he had ever witnessed, and attributed it to fracture of the jaw from violence when the tooth was extracted. He could not, of course, say whether the man had not, subsequent to the extraction of his tooth, been exposed to noxious emanations, such as those from phosphorus, although the history did not indicate such exposure. This being the most frequent cause of necrosis in this bone, it was always advisable that persons engaged in working in phosphorus should not return to work immediately after the extraction of teeth, or until the socket of the tooth had

healed.

Dr. M. exhibited the patient Sept. 26th, one week after the operation. Wound healing well. No pain, and no discharge from mouth.

that we had wounded the artery, but thig hæmorrhage would generally cease in a few moments. He preferred the common silk ligature, tied in two single knots so as to form one flat knot, to the double knot, which was not tight. The two ends of the ligature depending from the wound were knotted together. Interrupted sutures and strips of adhesive plaster placed between the sutures. Leg extended and slightly flexed, and enveloped in cotton bat ing, maintained in position by a light bandage, preferably of flannel.

CASE IV.-Sloughing of both Feet from Frost-Bite: Contraction of the Tendines Achillis: Tenotomy.-The man had lost both feet, at about the tarso-metatarsal articulation, three years ago. The attachments of the anterior muscles being lost, the tendines Achillis had gradually drawn up the heels of both feet, so that he had become unable to walk, and had crawled upon hands and knees for some time. Dr. Mott cut the two tendons, and applied an apparatus intended to draw the anterior ends of the stumps upward; it consisted essentially of a strong india-rubber band attached to the front of the shoe and above to the leg; the heel of the foot was firmly secured by a strap over the instep. The difficulty of applying an apparatus in this case arose from the want of sufficient stump to obtain good leverage. The man had constitutional syphilis of four years' standing. In performing tenotomy on this tendon, Dr. Mott preferred to cut from above downward, after the knife was introduced through the skin.

CASE II.-Popliteal Aneurism.-Man, æt. 35, Irish, pedler. Admitted August 10th, 1868. Always healthy, a great walker, and accustomed to carry heavy loads. Had had, for several months, a swelling in the left popliteal space; four weeks ago, after a long walk, the tumor became inflamed, and for this he entered the hosCASE V.--Ligation of Femoral twice, and subsequent pital. Aneurism was diagnosticated. Slight hæmor- Ligation of External Iliac.-A young man had wounded rhage occurred from rupture of the sac, ten days after his right femoral artery, with a penknife, in the lower admission, for which the femoral artery was tied by Dr. part of Scarpa's space. A silver ligature had been Mott, August 20th. The ligature came away on the four-placed around the artery in the upper part of that space teenth day, and about the same time the tumor began to by another surgeon, but did not constrict the artery slough. The wound of operation had now nearly healed. sufficiently. Hæmorrhage occurred, and Dr. Mott tied The bone, at the seat of the tumor, was denuded from the artery with a silk ligature, beneath Poupart's ligapressure of the tumor upon it, and was indicative of a ment. The ligature came away in fifteen days, and longer existence of the disease than the patient had re- hæmorrhage again occurred. He then tied the external ported. An interesting feature in the case, and one iliac, and the patient had entirely recovered. Dr. Mott which perhaps bore upon the causation of the aneurism, strongly advised using silk for ligating arteries; silver was congenital deformity of the left arm and leg. The wire was not secure, and should be used only for sutures. leg was about two inches shorter than the right one, and the foot contracted, somewhat resembling talipes CASE VI.-Pott's Disease.-Boy. Disease of three equino-varus. This shortness of the leg would necessi- this disease we should imitate nature. Nature attemptDr. Mott remarked that in treating years' standing. tate greater muscular effort upon its part. The man ed to establish a discharge from the carious bones by also had constitutional syphilis, as shown by the coppery forming abscesses, which would open in the back or blotches on his legs; this taint might also have had loins, or, if neglected, the pus would find its way out some bearing upon the predisposition to his disease. through a psoas abscess. Hence, from a large experience in these cases, he strongly advised establishing an issue early; even in cases in which paraplegia existed, he had seen the use of the limbs partially restored under this treatment in the course of two or three weeks, and ultimate recovery take place. Two is-ues on the sides were better than one only. Support to the sides of the trunk by appropriate apparatus, and tonics with nutritious diet would complete the treatment.

SEPTEMBER 26, 1868. CASE III.-Popliteal Aneurism: Ligation of the Femoral in Scarpa's Space.-This case differed from the preceding, in that the man was healthy, and his disease arose from injury received by jumping from a cart and falling between two rocks, probably rupturing the popliteal artery. He had the sensation, at the time, of "blood pouring into his boot," although, on taking it off, no blood was found. The aneurism was of nine months' standing, growing steadily from the time of injury. It was a much more favorable case for operation, since, apart from his excellent constitutional condition, the disease was in the second or more fluid stage than the previous case, and therefore less likely to slough whereas, in the previous case, the aneurism was of such long standing as to have produced disease of the bone. Ether and chloroform were given freely, and the artery was tied in the usual way. Dr. Mott remarked that it was not unusual to wound some of the small veins overlying the artery and entering its sheath. Blood would well up suddenly in the wound, and we might imagine

CASE VII.-Pulsating Cervical Tumor.—Woman, æt. 57. Had been in the habit of carrying heavy weights on the head. Generally healthy. Drank spirits more or less. Had received hard usage from her husband, having frequently been beaten over the head. A pulsating tumor extended along the course of the right carotid artery from its origin, and extended tortuously upward from opposite the thyroid cartilage. The tumor was movable, and was probably the carotid dilated to more than double its natural size. There was no aneurismal bruit, and no other evidence that the disease was aneurismal. Its peculiar "elbow-joint" bend might be a provision of nature to prevent the formation of an aneurism.

BELLEVUE HOSPITAL MEDICAL COLLEGE.
CLINICAL LECTURES OF PROF. WILLIAM H. VAN BUREN.
SEPTEMBER 17 AND 24, 1868.

[From the cases presented at these lectures of Dr. Van Buren, we select the following.]

to about its present size. On examination at this time, it was uniformly hard and smooth, and not painful on pressure. Owing to the existence of two stricturesone three inches and the other five inches from the orifice of the meatus urinarius--and of some gleet, he had pain radiating from the back down the legs. He had had clap three times. The left testis was healthy. The left inguinal glands were enlarged, and scars of buboes existed in the groins. There had been no headache or sore-throat. He was pallid, and, on a cursory examination, two tertiary blotches on the skin were found, which were as good evidence as many to a trained eye. This was a case of syphilitic sarcocele, or syphilitic testicle, as it was now called. In many points, as illusin these cases, it was similar to tuberculous testicle. Hydrocele occurred in both diseases. In the syphilitic, after tapping, we would find an enlarged syphilitic testicle behind. The appropriate treatment was specific. Dr. Van B. was very fond of giving a little biniodide of mercury, and a great deal of iodide of potassium. It often took a long time to reduce syphilitic testicle. In the present case he would give five grains of iodide of potassium, well diluted, two or three times daily, and increase by a grain or two every two or three days, until the testicle became softer and smaller. The syphilitic exudation between the tubuli seminiferi and the coils of the seminal duct, was similar to that of the socalled gummy tumors, and would be removed by iodide of potassium; hence some value might be attached to this drug in a diagnostic point of view, in case any doubt existed as to the character of the disease. In cases of syphilitic hydrocele, it was not well to inject tincture of iodine into the sac.

CASE I. Tuberculous Testis.-Irishman, middle-aged, boiler-maker. Partially deaf, an effect of his occupation. Has been in the United States twenty years. Mother died æt. eighty years, and father æt. fifty. One brother died at forty-six, of consumption. He himself was generally healthy, drank more or less, had a slight cough, and only a moderate appetite; he disliked fatty food. Never had hæmoptysis. Has physi-trated cal signs of pulmonary tuberculosis; pulse more frequent than natural. Three years ago he fell and broke his right arm and injured his head, but was not aware of having injured his scrotum. Three months later, his right testicle began to swell, and was opened; blood alone was discharged. Subsequently an abscess formed, and opened spontaneously at several points. There was no pain or dragging sensation in the scrotum. The right spermatic cord was thickened; the testis was hard, and slightly elastic; the epididymis was more solid. The skin was adherent over the tumor. Thin, unhealthy pus was discharged from the sinuses.

This was a case of tuberculous deposit in the testis, probably beginning in the epididymis, which is generally the history of this class of cases. Transportation over the ocean seemed to be a fertile source of the development of tuberculosis in the Irish. It had been popularly affirmed that fifty per cent. of our Irish population perished of this disease in its various forms. As manifested in the testicle, the inflammation was painless from the first, and indolent, the sinuses refusing to heal. It was more apt to attack young men, because the functional activity of the organ was greater in youth. In the present case, it is not unlikely that the primary tuberculous infiltration occurred in early life, but gave rise to no symptoms. The dislike to fatty food was a point to which Dr. Van B. had been led by his experience to attach great importance as bearing upon the existence of tuberculosis. The treatment in this case would be, first, to correct the constitutional condition as far as possible by enjoining the use of fatty food, especially in the form of cod-liver oil, and by giving a little stimulus, such as lager beer. The sinuses would not heal rapidly. If constitutional means did not prove successful, castration might become necessary. This was probably as safe an operation as any in surgery. Tuberculous discase of the testis was also interesting as having many points in common with pulmonary tuberculosis.

In regard to the differential diagnosis of the tubercular and syphilitic affections of the testicle, the information to be derived from an appreciation of the local features, was in Dr. Van B.'s observation unsatisfactory; and this naturally followed from the similarity in the pathological features of the two diseases. There is in each a deposit of morbid material in the glandular parenchyma in the one, of tubercular matter; in the other, of the gummy exudation peculiar to syphilis. The symptoms which follow naturally resemble each other in the two diseases. Both are chronic and painless. In both hydrocele is liable to occur, and both testes are apt to be affected. In both, after a time, there is a tendency to get rid of the morbid deposit by indolent and generally ineffectual suppuration and ulceration, with liability to sinuses and fungous testis. The syphilitic testis is more smooth and globular or ovoid in its shape, and when both testes are involved-which is often the case-the sexual powers are abolished, which is not often the case in the tubercular disease. The safest ground on which to base a diagnosis, is in the recognition of the patient's diathesis, and this is generally sufficient. Where both the tubercular and syphilitic diatheses coexist, as is compara-sometimes the case, the tentative administration of the iodide of potassium offers the best chance; for the syphilitic deposit will disappear under its influence, whilst tubercle is not affected by it.

He briefly recounted the case of a young man with the former disease in both testes; he had urethral hæmorrhage antecedent to its development, and subsequently double hydrocele; these were symptoms ble with haemoptysis and pleuritic effusion.

CASE II. Syphilitic Testis.-The patient was Irish, thirty-four years old, married five years ago. Had had two children, of which one had died. Had had several chancres the first fifteen, the last three years ago but could remember no subsequent eruption on the skin. Had come to this country when ten years old. His father died of "fever" at forty; his mother was living and healthy. One brother died young. He himself had been generally healthy; had yellow fever in New Orleans five years ago, but had been well since. Was a moderate eater, and rather thin. About five weeks ago he noticed slight pain in the lower part of the hypogastric region, and, while examining for its cause, accidentally discovered that his right testicle was enlarged

CASE III. Enlarged Prostate: Suprapubic Puncture of Bladder.-Dr. Van Buren gave the history of a case he was treating. A merchant, aged sixty-six years, reported himself unable to pass his water. Catheterism unsuccessful. An olive-headed bougie was finally passed, and the water drawn off. The posterior lobe of the prostate was very large, and pushed up the mucous membrane of the bladder, so as to form a kind of pocket at the beginning of the urethra. The difficulty recurred. Bougies and Mercier's catheter failed to pass. Forced catheterism was thought of, but not adopted. The patient had become delirious, and had fever and a

extract of hæmatoxylon, sixty grains; tincture of catechu, two drachms; caraway water and boiling water, of each five drachms; to be taken every four hours. Five or ten minims of tincture of opium are added in some cases to each dose. All patients are ordered to their beds, and to restrict themselves to milk.

During the past season a large number of persons have applied to the Charing Cross Hospital for treatment. The hall porter gives to casual patients a simple astringent mixture, made of rhubarb and chalk mixture. These articles constitute the basis of the treatment of diarrhoea at this hospital. Dr. Julius Pollock gives dilute sulphuric acid, with tincture of krameria, opium, and cinnamon-water, when the flux lasts quite a time. He also orders, when there is abdominal pain, mustard and linseed poultices, or hot fomentations to the belly.

among delicate and ill-nourished children. This disease is often confounded with mercurial salivation, but may easily be diagnosed by an account of the case, and by the fact of this disease attacking only one side of the mouth, while mercurial sloughing occurs at both sides.

Treatment of TONGUE-TIE.-Mr. Maunder, of London

Hospital, lacerates or tears the membrane with the forefinger. The finger is introduced into the mouth under the plea of examining the deformity, when pressure is made downwards and backwards towards the floor of the mouth, and the frænum is torn by the finger-nail. This plan, he states, is very acceptable to mothers. TO RELIEVE PAIN IN OPEN CANCER.-In the London Middlesex Hospital (Lancet, Aug. 8, 1868) the intense pain of open cancer is best relieved by the stramonium ointment. The following formula is the one in use at that institution: Half a pound of fresh stramonium leaves and two pounds of lard; mix the bruised leaves with the lard, and expo e to a mild heat until the leaves become friable, then strain through lint. The ointment is spread upon lint, and the dressing changed three times a day."

PROLONGED SUPPRESSION OF URINE.-Dr. Gallina, of

Between July 4th and 18th, 112 patients with diarrhoea were treated at St. Thomas's Hospital. Twentyfour pints of diarrhoea mixture were given out by the porter in single doses. A great many of the cases were children. For infantile diarrhoea, Dr. Jervis gives decoction of logwood mixed with lime-water. Dr. Barnes uses kino, catechu, or krameria, with the decoction of logwood. The resident medical officer, for casual cases, gives a dose of the hospital mixture, made as follows: tincture of rhubarb, half a drachm; tincture Leno Bresciano, mentions (Gazetta Med. Ital. Lombardia) of opium, ten minims; aromatic spirit of ammonia, one the following remarkable case: A mother, aged 27, drachm; and peppermint water, an ounce and a half; married, applied to him for treatment after suffering for combined with a couple of grains of calomel. When five months from amenorrhoea and leucorrhoea, and had there is vomiting associated with diarrhoea, Mr. White-not passed any urine for the previous twenty-four hours. field orders twenty minims of chlorodyne combined with He removed by the catheter a few drops of dark coffeefive or ten grains of carbonate of soda. colored fluid. For the next eight days no urine appeared, and leeches were applied to the perineum and the nitrate of urea given. Leeches and tepid baths were constantly made use of until the patient reached the twenty-fifth day of suspension, when she consulted Dr. Albertini, of the Milan Hospital. Her general health had not suffered. After a careful examination of two hours, nothing could be detected amiss aside from the absence of a secretion of urine. Professor Rodolf, of Brescia, was also called in consultation, and was perDr. Duffin, of the King's College Hospital, gives cas- suaded that the suspension was due to amenorrhoea. Emtor-oil, followed by chalk mixture. The regular diar-menagogues were given, which produced the menstrurhoea mixture of his hospital is composed of castor-oil, tragacanth, and oil of cinnamon.

The usual treatment in the London Hospital has been, when the stomach was foul at the commencement of the disease, castor-oil and laudanum, and patients directed to place themselves in the recumbent posture, with farinaceous diet. When the tongue was clean, aromatic sulphuric acid, with logwood decoction, paregoric, and chloric ether, was ordered. From June 29th to July 27th, 5,719 patients applied for treatment in this affec

tion.

al flux. Six hundred grammes of urine were drawn off by the catheter on the forty-third day after the suspension. The day after the withdrawal of the urine it passed spontaneously, and continues to do so at last accounts, her health not having suffered from this prolonged suspension.

Between 200 and 300 patients daily have attended the University College Hospital, although it is situated in a healthy locality. But persons come from Whitechapel and the south side of the Thames, because the diarrhoea mixture given out there is so agreeable to the taste-being composed of dilute sulphuric acid in an aromatic water; now a small amount of assafoetida has been added, which does not make it quite so agree-centrated form it may be substituted for nitrate of silver. able.

At Guy's Hospital, the ordinary treatment is by astringents, the chalk, opium, and catechu mixture. Sometimes a little Dover's powder is prescribed in the julep ammonia of the Hospital Pharmacopoeia.

Dr. Basham's favorite prescription at Westminster Hospital is sulphuric acid and laudanum, five minims of the former and three of the latter to an ounce of water. The compound rhubarb mixture (containing tincture of rhubarb and chalk) is often prescribed at this hospital. Chalk mixture is mostly given to children.—Med. Times and Gazette, Aug. 1, 1868.

DIAGNOSIS OF CANCRUM ORIS.-At the Dublin Hospital (Med. Press and Circ.) Mr. Croly, one of the hospital surgeons, made some remarks in reference to the diagnosis of this disease, after an operation made on the person of a little child 5 years of age. He stated that eancrum oris is a curious sequela of measles, and found

THYMIC ACID. The essential oil of thyme is the parent of this acid. Its composition is C20H14O2, and is without smell, with powerful antiseptic qualities. In a con

As an antiseptic, it should be dissolved in 1000 parts of water, with an addition of a little alcohol.-Lancet.

A CASE OF ULCERATION OF THE EAR.-Quite an interesting case of ulceration of the ear, with chronic inflammation of the auditory canal, and thickening of the vocal cords, is narrated by T. F. Rumbold, M.D., St. Louis, Mo. (The Humboldt Med. Archives). A female, aged 22, stated to him that when seven years old she had an attack of typhoid fever. Upon recovery it was observed that she was entirely deaf, so much so that the loudest thunder was not recognized.

For several years she was answered by signs after speaking to those around her. In the course of time she was sent to the Fulton Institution for the Deaf and Dumb, and graduated there. On her return home she had forgotten the language of ordinary conversation, and conversed "on her fingers."

In the spring of 1863, her hearing improved to such