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majority were selected cases, adapted for this variety ofoperation.The treatment of intestine, when gangrenous, is well laid

down. The following contains the pith of Mr. Teale’s re-marks:-

.. When the gang-rene is general, or even extensive, an inci-sion must be made throughout the whole length of the gan-grenous portion of intestine, which must be left in the sac tobe detached by the sloughing process. The opening thusm:1.cÌe generally allows of the free evacuation of the contentso the upper portion of the alimentary canal, without divisionof the stricture. If, however, the stricture should still afforda material obstacle to the discharge of the intestinal contents,a director must be passed beneath it, and its division effectedwith as little disturbance as possible of the neighbouring ad-hesions. The wound must afterwards be left open, to facilitatethe free discharge of matters, and simply dressed with wetlinen frequently renewed."-p. 131.Where the hernial tumour is omental,-and this is diseased

or gangrenous,-it is shown to be the best practice, to dividethe diseased part, and then to ligature the vessels, so as toavoid haemorrhage. The accidents of the operation for hernia,such as wounds of the intestine and bloodvessels, and theprinciples of treatment subsequent to the operation, are nextbriefly described.In the twelfth chapter, the evils of reduction en masse, as

we have already said, or the conversion of an external hernialtumour into an internal one, are pointed out, and a most in-structive table given of twenty-one cases in the practice ofArnaud, Dupuytren, Bransby Cooper, Luke, and others, withthe species and character of the hernia, and the treatmentand result. Ten of these cases are given as terminatingfatally, but the termination is omitted in many of the list.The chapter on intestinal fistula consequent upon gan- i

grenous or wounded hernia, is full and complete. The de- Iscription of the spontaneous cure of accidental anus, and therestoration, by the aid of the sac, of the canal, for the progressof intestinal matter from the upper to the lower part of theintestine, is very lucid. In the anatomical character of intes-tinal fistula, the acute angle formed by the two portions ofintestine opening upon the skin, with the promontorio of

Scarpa at the angle of union of the two portions, is carefullygiven, and followed by a detail of the complications of in-ternal fistula, particularly prolapse of the bowel, from theabsence of sphinctorial power, and the consequences of thisaccident.In the treatment of intestinal fistula, we have an account of

the beautiful operation devised by Dupuytren for destroyingthe angle between the two portions of intestine, and thusrestoring the natural cavity. By the enterotome of Dupuy-tren, a kind of self-acting forceps, the two blades of whichwere introduced into the two portions of intestine, continualpressure was exerted on the intestinal angle; this producedadhesive inflammation between the two portions, and ulti-mately the destruction of the angle by pressure, when, after afew days, it came away loose with the forceps. Unfortunately,this operation has not been so successful in the hands ofothers as in the hands of Dupuytren and those who imme-diately followed him. Of forty-one operations performed byDupuytren, Lallemand, and others, three-fourths of whichwere caused by gangrenous hernia, death was recorded in threeonly; in nine, the fistulous openings remained more or less, butthey were permanently and completely cured in periods vary-ing from two to six months. The operation has been modifiedby Delpeau, Bourgery, and others; but for a full account wemust refer our readers to the work of Mr. Teale itself.In the second part of the volume, the species and varieties

of abdominal hernia are separately considered: this part con-tains, in a condensed form, almost everything known to sur-xery, of importance, relating to inguinal hernia, oblique anddirect, hernia of the tunica vaginalis, femoral hernia, umbilicalhernia; and the less frequent forms of the disease, the minorhemis, ventral obturator, ischiatic, perinseal, vaginal, pu-

dendal, and diaphragmatic. Here we must again refer ourreaders to the work itself.

i We observe that, on the strength of the report of the com-mittee of the Philadelphia Medical Society, Mr. Teale speaksin very high terms of praise of the block-trusses invented byDr. Chase. These trusses are said to be admirably adaptedfor oblique and direct, inguinal, and umbilical, and femoralhernise. A first-rate truss is still such a desideratum, that itis unfortunate Mr. Teale is unable to speak of the merits ofDr. Chase’s trusses from actual observation. If they reallybear out the eulogium of the Philadelphia Medical Society,the sooner they are introduced into this country the better.Of these trusses it is said, that the retentive power is so per-fect, and the comfort experienced by patients so great, thatthey "generally relinquish its use unwillingly, and sometimesabsolutely refuse to do so, when pronounced cured by the sur-geon." This is of the truss for oblique inguinal hernia; itsavours strongly of hyperbole, but the matter should be tested.We have thus followed Mr. Teale through his treatise,

which, as its title sets forth, is essentially practical-practical,too, in the best sense, as based upon scientific principles. Itcontains sixty well-devised and well-executed woodcuts. Itcomes from a provincial hospital surgeon, in a town wheresurgery has always stood high, and it is sufficiently sound andgood to assert the abilities of provincial surgeons, and to main-tain the reputation of a successor of HEY.

Foreign Department.ACADEMY OF SCIENCES.

An Inquiry into the Cause of some Accidents after AmputatÙ:ms.THE following is a brief extract of a memoir, addressed by

M. MELCHioR ROBERT to the Academy of Sciences, on theaccidents which may follow the section of tendons and theirsheaths, more especially in amputation; and on the mechanismof the production of these accidents, and the means of pre-venting or remedying them. The author’s attention was par-ticularly drawn to this matter, from observing the frequentlyoccurring untoward events after amputations near the ex-tremities of limbs, and when, consequently, the greatestnumber of tendons and tendinous sheaths is cut through. Toarrive at an explanation of this circumstance, M. Robert hasperformed numerous experiments on the dead subject, andon the lower animals. The following is a resume of the re-sults he has arrived at :-

1. That after amputation and the division of tendons, thelatter recede into their sheaths to different heights; this re-traction must therefore act in the same manner as the risingof a piston in a pump.

2. This retraction will consequently be attended by theintroduction into the sheaths of liquid or air, according to themedium in which the operation is performed.

3. The liquid at the surface of the wound will be sucked inwhen the limb is extended, and expelled, more or less com-pletely, when it is flexed.

4. It is possible to drive the liquid out again by means otpressure properly applied, or to withdraw it by suction with asyringe.

5. The retraction of the tendon in its sheath, and the im-bibition of any liquid or of air, may be prevented by pressurealong the course of the sheath whilst the operation is beingperformed.

6. Lastly, fluid or air may be quite excluded from thesheath, by passing a ligature round the latter.These phenomena being demonstrated in the dead subject,

and in the lower animals, M.Robert concluded the same to takeplace in the human subject when operated on; and that bloodor air, or both, may enter the tendinous sheaths, and which,if not expelled, will light up inflammation, followed by suppu-ration, or may even favour the occurrence of purulent absorp-tion. And after an operation, the various movements of thelimb required by the surgeon in- examining it, those excited-by the patient, and the traumatic contractions of the muscles,will all cause the tendons to play up and down in theirsheaths, and so favour the introduction of air or liquids whichare in contact with the cut surface. As practical deductionsfrom his experiments, M. Robert would adduce the followingpropositions:

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1. That during the operation, compression should be exerted, action of all the parts of the vocal apparatus; but it is par-whenever possible, in the course of the sheaths, above the ticularly in the vocal tube that the cause of the modificationspoint where they are to be cut across, in order to close the is to be found.sheath, and to retain its enclosed tendon in its position on a 3. The pharynx, the mouth, and the nasal cavities, bylevel with its extremity. acting more or less apart, or by combining in action, give to a

2. After the operation, to pass, by a curved needle, a liga- sound very various timbres. If the vocal tube has a largeture around the tendon and its sheath, so as to bring its sides dimension, the sound augments in volume, and becomes grarein contact, and obliterate the cavity. or dull. * The pitch is, on the contrary, so much the clearer

3. If the tendon, during the operation, is allowed to escape, or shrill, as the dimensions of the tube are smaller.and retract itself within its sheath, to withdraw it again, by 4. The clear and the deep timbre have different degrees:either forcibly flexing the limb, if the tendon belong to a their production does not result from a particular form of theflexor, or by seizing it with forceps, and then tying it as tube. The fixity of the larynx, generally given as character-before directed. istic of a deep note, may, to an equal degree, belong also to the

4. If the tendon has so far receded as not to be again reco- clear timbre; for if one executes a roulade or shake in a lowverable, the sheath alone is to be tied; but before tightening note, the larynx offers in every respect its usual mobility.the ligature, any air or liquid should be expelled by compres- 5. The timbre of the improperly called guttural note ispro-sion or suction. duced whenever the glottis vibrates with a very short tube.

5. Along with the preceding precautions, the operator 6. The vowels, which may be considered as so manyshould guard against extending the limb in his examinations, timbres, correspond to the form and dimensions of the buccalas also against too strong pressure, both of which, as at the cavity.wrist, cause the retraction of the tendons, and favour the in- 7. When a sound traverses the nasal cavities, it may pre-troduction of fluids. sent three principal varieties. In the first case, the mouth

6. As soon as the patient complains of acute pains along being shut, if the sound is driven through the nasal cavities,the course of the tendinous sheaths, methodical pressure the latter give passage to it without being able to arrest or toshould be exerted, or, if possible, suction be attempted retain it, and the timbre is but slightly nasal. In the secondfrom the ends of the sheaths. Perhaps it might be good case, if the sound pursue its course through the mouth, whilstpractice to inject an emollient liquid into them, to be again the external orifice of the nasal fossae is closed, the timbrewithdrawn. becomes extremely nasal if the sound be directed into theM. Robert has made the preceding observations especially cavity of the nose, for then it is retained at every part. In

respecting the tendinous sheaths of the wrist, fingers, and toes, the third case, if the sound be directed into the same cavitybut believes them also to apply in other cases. whilst the mouth and nose are both open, it will at onceThe preceding experiments are interesting, if they lead to escape from the two; but the sound will ring in the posterior

no practical results; and they indicate in M. Robert, who is part of the nasal fossas. In this last case, the timbre will bebut an interne of the hospitals, a spirit of original research. less nasal than in the preceding, but much more so than inBut the observations are considered of sufficient importance the first. One sees from this, that we must carefully distin-by the French Academy, that a report is ordered to be drawn guish the sound which escapes through these cavities, andup on them by three of its very eminent members, MM. Roux, that which rings in them. It is in this distinction that weVelpeau, and Serres. - find an explanation of all the phenomena of the nasal voice.

The Rice-water Evacuations of Cholera..... ’ 7

T., ,

The Rice-water Evacuations of Cholera. ,1 Composition of the Blood in New-born Animals .1". 1B’[ A NDRAL read a note before the Academy on theeompo- a note detailin some ex erimentsSition of the white or rice-water evacuations from the intas- , 1%f. PoGGiALB addressed a note, detailing some experimentssition of the white or rice-water evacuations from the int3s- he had made touching the composition of the experimentstines in cholera. These evacuated matters are known as con- he had made touching the composition of the blood in new-sisting of two portions-an abundant liquid portion, in which opinion among and on which there has been much diversity ofthe other, a grumous, solid matter, is suspended ; and they opinion among chemists. The following are the conclusionsare devoid of bile. Some have supposed these peculiar eva- at which proportion arrived:-cuations were derived directly from the constituents of the whilst The proportion of water in the Nood is rather high,blood, the liquid portion being made up of serum, with albu- 2t that of fixed matters animals is very rich in globules,men, the solid of fibrine. But chemical and microscopical and The blood of new-born animals is very rich m globules,examination has proved this notion to be erroneous. There are and poor quantity cf albumen matter seems to

no traces of albumen in the liquid part, and the composition of 3. The quantity of albumen and of fatty matter seems tothe whitish grumous matter is not at all fibrinous. The 4. The the sambas that found abundant in the blood of thegranular portion under the microscope appears as if made up 4. The oxide of iron is more abundant in the blood of theof pus-globules, but yet not partaking of the characters of pus. newly-born..., .M. Andral, consequently, regards the grumous matter to be Of all the ammals whose blood he submitted to examitiation,derived from the intestinal mucous membrane, and from a that of young dogs alone presented a considerable proportioncondition apart from inflammation; and he draws the follow-

of globules. Among them, the mean proportion was 162.30.

ing couclusions:- and he draws the follow- Among other young animals, he found less fixed matters and1. The white matters which fill the digestive tube of globules than in the adult state; however, the number indi-

patients suffering from cholera are not composed of the ele- catingrthe proportion of globules is always relatively higher;ments of the blood, for neither albumen nor fibrine are dis- that of fibrine is very low. ————

covered in them. only of mucus, secreted very rapidly Existence of a False -ivembrane in the Purulent Ophthalmaia

.

2. They are formed only of mucus, secreted very rapidly Existence of a False Ophtalmiaand in excessive quantity, and withal modified in its qualities. ,

of Infants. -

3. What proves the mucous character of these matters is, At the seance of the Academy, August 23rd, M. VELPEAUthe existence of numerous globules with nuclei, like those of communicated a letter he had received from M. CHASSAIGNAC,plus-globules, but differing from the latter in every other cir- physician to the Hospice des Enfans Trouves, on the Purulentcumstance but outline. Ophthalmia of Newly-born Infants.

4. The examination of the blood in cholera shows that its The writer observes, that in the little children under his

albumen exists in its normal quantity. charge, attacked by purulent ophthalmia, he has noticed that5. The theory which refers the symptoms, occurring when after the internal surface of the everted eyelids have been

the blue tint-cyanosis-overspreads the surface, to the washed (irrigated) for some time, and after the completechange which the blood undergoes in its composition, from a removal of purulent and mucous matters, it becomes easy

great and sudden loss of its serum, cannot be admitted. to recognise and to study the false membrane which exists____ upon them in most children affected with this malady.

.. - . This membrane presents itself under the appearance oi a

On the Pztch (Timbre) of the Human Voice. greyish layer, semi-transparent, that bathing and a small jetM SECOND communicated a memoir to the Academy, on the of fluid falling on it fail to remove. By gently scraping this

modifications of the pitch of the human voice. The following layer, it can be readily ascertained to consist of a membrane,are the conclusions at which he arrived:- of tolerable consistence, so much so as to allow of being

1. The timbre is not, like the tone and intensity, a simple removed in one piece, when it is drawn away with care; it io

quality of sound, but depends always on several circumstances very fine, but becomes thickened by the prolonged action ofa. acollectively. jet of water. Although semi-transparent before the action at

2. In the vocal apparatus, the modifications of the pitch this liquid, it becomes opaque when bathed with it for a fewresult from the general state of the system, and from the instants. It covers over the conjunctiva throughout, but its

285

existence over the transparent cornea, though real, it is moredifliciilt to determine. Its transparency, before acted on bywater, is such, that it allows the redness of the subjacentmueous membrane to be perceived through it, the brilliancyof which it detracts from very slightly. When this mem-brane is raised at a single point, and it is attempted to detachit gradually, it separates itself from point to point, like amembrane universally adherent.Thi" kind of accidental lamina over the mucous membrane

of the eye and eyelids is a manifest obstacle to the direct ap-plication of therapeutical agents to the diseased conjunctiva,an obstacle so much the more mischievous, as it is, accordingto all appearances, almost always mistaken in practice. Ihave determined the existence of this membrane under twodifferen- circumstances. 1. In cases where there is no traceof conjunctival erosion beneath it, and 2, in cases where thiserosion is so marked that the free surface of the conjunctivadoes not differ from a recent wound, and is, at the same time,covered by a purulent and bloody secretion. It has appearedto me, that in all cases where this false membrane has beenremoved by pulling it away with forceps, the cause of thepurulent ophthalmia was auieliorated in the most evidentmanner, either by the very. fact of the disappearance of thisforeign matter, or in consequence of the immediate action oftherapeutic agents on the diseased tissue.The second point on which I wish to call attention is, the

very remarkable action of jets (douches) of fluid on the con-junctiva, let fall from a height more or less considerable onthe eye and eyelids. This action is so beneficial, that in an in-firmarv, where one had almost daily to deplore the occurrenceof blindness in several new-born children, from softening ofthe cornea,-a softening which is sometimes complete at theend of forty-eight hours,-there has not been, since the em-ployment of this method of irrigation, a single example ofthis most sad accident. A young physician attached to theinfirmary, and who, in the performance of his duties, was at-tacked with this eminently contagious ophthalmia in theseverest form, is indebted for a rapid cure to the prolongedemployment of these conjunctiva! douches.From his extended observation of this disease, M. Chas-

saignac would draw the following conclusions:-1. Purulentopththalmia of new-born babes is, in the majority of cases; ifnot in all, a diptheritic pseudo-membraneous ophthalmia.2. The diptheritic membrane is consistent, adheres firmly tothe conjunctiva, and cannot be detached completely from it,either by repeated washings or by the friction of a softbody, such as a sponge or wet lint, but by seizing it with aforceps it may be removed in a single piece. 3. The removalof this false membrane hastens, in a remarkable manner, thecure of the ophthalmia. 4. Conjunctival douches, and pro.longed irritation of the eye and of the internal surface of theeyelids,bring about the rapid cure of this purulent ophthalmia.The formation of a false membrane on the conjunctiva has

been before noticed in cases of very acute ophthalmia, as inone recorded in the last volume of THE LANCET, p. 492, in a

man in whom the prolonged action of cold seemed to inducfthe disease; the eye, however, being very prone to inflamma.tory attacks.

____

British and American Medical Journals.THE PROPRIETY AND PRACTICAL UTILITY OF CLASSIFYING HOOPING-

COUGH AMONGST THE EXANTHEMATA, WITH A NEW THEORY OFTEAT DISEASE.

TilE number of the Dublin Journal from which we quoted (atpage 203) the very excellent exposition of Messrs. Ledoyenand Calvert’s quackery, contains itself an article which issingularly exposed to criticism. Under the above title, awriter, named JAMES F. DUNCAN, M.D., F.K. and Q.C.P., extra-physician to Sir Patrick Dun’s and Mercer’s Hospitals,lecturer on practical medicine, &c., propounds as ridiculous atheory as ever graced the most fanciful of medical ages. Hecommences by an expression of surprise at the neglect withwhich nosology is at the present day treated, and then seeksto explain why this occurs. The difficulty of the subject onthe one hand, and indifference on the other, are stated to bethe chief sources of this unmerited disregard.

" Yet it can scarcely he denied, that an arrangement ofdiseases founded upon the real relations subsisting betweenthem, if such could be obtained, and grouping together those

which partake of the same essential nature, would be not onlyhighly interesting in a scientific point of view, but of extremeimportance in actual practice.’Most true Dr. Duncan; and had you been thus guided in

your arrangement, the plague, hooping-cough, and mumps,would not have taken their places in the same group ofdiseases. When a multitude of individual instances or objectspresent themselves, memory, without arrangement, is lost indetails. But in making these arrangements or classes,peculiar and distinguishing heads must be sought. For

instance, in botany, how useless would it be to collect- in onevast assemblage all plants growing from the earth by rootswith erect stems, green leaves, coloured flowers, male andfemale organs of generation, &c.; or in zoological science, togroup all animals with four legs, two eyes, a tail, the bodycovered with hair, and feeding on vegetables. Yet it is on

characteristics not less general than these, that the writerproposes to form his group of exanthemata. Thus-1. Regu-larity of course; 2. Universal susceptibility to their influence;3. Occurrence but once in life; 4. Propagation by specificpoison; 5. Possibly all may be propagated by inoculation; 6.They are all attended with fever. Such characteristics hebelieves common to small-pox, measles, scarlatina, varicella,vaccinia, maculated fever, plague, mumps, hooping-cough,consequently something "highly interesting in a scientific

point of view, and of extreme importance in actual practice,"is accomplished, that is, if we admit the value and usefulnessof such sweeping generalization as this. Yet general as it is,the exceptions are so great, that there is scarcely one of theabove diseases which may not be removed beyond its pale-for example, hooping-cough. Is it regular in its course? Areall people susceptible of its influence? Can it be propagatedby inoculation? Is it attended by fever? Mumps, again,will it answer the queries just put? Are those diseases so

analogous in character with plague and spotted fever, thatthey will admit of similar treatment, and thus establish pointsof " extreme importance in actual practice." No; certainlynot. Classification of disease or nosology, to be useful, musthave for its foundation the proximate causes of disease-it isto these we must look for its distinguishing and essentialfeatures. It is the ardour with which these causes are now

sought, that causes a nosology little better than a list ofnames to be neglected. As these causes are discovered-asdisease is traced to its elements-the heads for classificationwill develop themselves, and we shall no longer find mumps,hooping-cough, spotted fever, and chicken-pock, placed sideby side under a name which expresses a character belongingto other diseases, and to none of these diseases which havescarcely anything in common, except that of having been, onthe present occasion, thus rashly thrown together.

MEDICAL EDUCATION IN THE UNITED STATES.

In an address to the Philadelphia Association, Dr. STILLEcontroverts the [characteristic] assertion of Professor Paine," that American physicians greatly surpass all other nations,not only in the decision, but in the success of their practice ;’and argues that in attainments, so far from being equal tothose of the different nations of Europe, they are greatlybehind, and therefore cannot possibly surpass them in decisionOr success in the treatment of disease. After contrasting thequalifications for entering upon the study of medicine de-manded in various sections of Europe, with the loosenesswhich prevails in the United States, the lecturer makes thefollowing statement :-

" After all the preparatory study we have described, whatterm of attendance on medical lectures is required of Euro-

pean students? ? In Austria and France, fifty months; inPrussia, and the secondary states of Germany, forty months;in Great Britain and Ireland, twenty-four months; while in