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came in, and secured the vessel below in a very dexterousmanner. If Mr. Clark had come in before, he (Mr. Solly)thought that he could have so commanded the haemorrhage bypressure on the vessel, as to have enabled him (Mr. Solly) tohave searched for, and secured, the ends of the divided artery.Mr. B. CoopEit meant his observations to apply only to cases

precisely similar to the one under discussion. If only thebranches of the external carotid were wounded, it might bebetter to secure the ends of the divided vessels; but here thewound was of the external carotid itself, and therefore it wasnecessary to secure the common vessel.Mr. SoLLY referred to the great loss.of blood in the case re-

lated, as the cause of the very little head excitement whichfollowed the employment of the ligature. With regard to themode of treatment pursued in this case, it must be recollectedthat there was some question as to which vessel were reallywounded. The man had been brought to the hospital all theway from Gracechurch-street, and the wound had ceased tobleed, the haemorrhage returning after his admission into theinstitution. Mr. Solly referred to a case admitted some yearssince, under the care of Mr. Travers, of a man, who, whilstincarcerated in a watch-house, stabbed himself with a penknifejust under the lower jaw. For this wound, Mr. Travers tiedthe common carotid. A few days afterwards, suppurationtook place in the wound made in the operation, bleeding cameon, and the man sunk.Mr. LE GROS CLARK had guarded himself in his remarks on

this case, by saying that he should pursue the same treatmentin cases of a precisely similar character. In this case, it wasprobable that the external carotid was wounded, or, at least,some of its branches, and perhaps the internal carotid also.Under these circumstances, it was best to secure the commoncarotid. He thought, however, that even when the wound wasconfined to one or two branches of the external carotid, andhaemorrhage occurred to a great extent, a ligature of thecommon vessel might be required as urgently as though theexternal carotid itself had been divided.

SOME INSTANCES OF THE CONTRAST BETWEEN DELIRIUM TREMENS

AND INFLAMMATION CF THE BRAIN AS REGARDS THE QUANTITYOF PHOSPHORIC ACID EXCRETED BY THE KIDNEYS. By H..BENCE JONES, M.D., F.R.S., Physician to St. George’s Hos-pital.Phosphoric acid is excreted combined with the earths and

with alkalies. From one-fourth to one-eighteenth of thephosphates in the urine are found to be earthy, and fromthree-fourths to seventeen-eighteenths alkaline phosphates.Hence, the sum of the alkaline and earthy phosphates mustbe determined by analysis. The following cases of deliriumtremens present the lowest limit to the amount of phosphates,in an extended inquiry published in the Philosophical Trans-actions for 1845 and 1846. In the lowest instance, the total phos-phates equalled only ,06 per 1000; urine, specific gravity 1017,9;whilst, in the cases of inflammation of the brain, the highestlimit found for the total phosphates equalled 13,38 per 1000;urine, specific gravity 1031,1-that is, 223 times less in theformer case than in the latter disease. In the three caseswhich are here related of inflammation of the brain, theaverage quantity of phosphates is 8,26 per 1000; urine, specificgravity 1025,3. During the acute stage of the three cases ofdelirium tremens, the average quantity of phosphates is only,67. per 1000; urine, specific gravity 1020,4. Hence, then,sometimes at least, an analysis might determine whether de-lirium tremens or inflammation of the brain was present. Butit is not every case of delirium tremens which exhibits thisdiminution, and it is not every case of inflammation of thebrain which shows an increase of the phosphates. For if foodcan be taken in delirium tremens, the food furnishes phosphateswhich hinder the diminution from being apparent; and if theinflammation of the brain be slight, the limits of variation inthe healthy state rise so high, that the slight increase, if pre-sent, cannot necessarily be considered as the result of inflam-mation : so that the chemical analyses can only be regardedas an assistance to the diagnosis, and not as alone sufficient todetermine in all cases what the disease may be.The first case of delirium tremens was that of a young

woman, aged thirty-two. On the sixth day of the acute attack,the total phosphatic salts = 1,07 per 1000; urine, specificgravity 1028,7. She recovered.The second case of the same disease was that of a man, aged

thirty-five. On the fourth day of disease, the total phosphaticsalts = 2,40 per 1000; urine, specific gravity 1019,1. On thefifth day, the total phosphatic salts = ,15. A second experi-ment gave ,12 per 1000; urine, specific gravity 1019,3. On thesixth day, the total phosphatic salts = ,06 per 1000; urine,

specific gravity 1017,9. In the evening of the same day, thetotal phosphates =,24 per 1000; urine, specific gravity 1019,7.The seventh night, the patient died.The third case of delirium tremens,-that of a man aged

thirty-five,—on the fifth day of the disease, gave total phos.phates = ,10; and in second experiment with the same urine,,09 per 1000; urine, specific gravity 1018,0. The sixth day,he took his food, and the total phosphates = 6,10 per 1000;urine, specific gravity 1022,5. He rapidly improved, and leftthe hospital well.The first case of inflammation of the brain was that of a

vonns man aged twentv-eisht. On the

There was lymph in the sub-arachnoid cellular tissue at thebase of the brain. The ventricles were distended with fluid;the septum broken and flocculent; the fornix and corpus cal-losum not softer than natural.The second case of inflammation of the brain was that of a

man, aged thirty-six, with much more acute symptoms than inthe previous case.

The ventricles of the brain were much distended; the wallsof both lateral ventricles much softened; fornix and septumlucidum different; softening of the lower part of anteriorlobes on both sides; arachnoid membrane at the base opaque.The third case was that of a man, aged thirty-six, with acute

symptoms supervening on chronic disease.

Five weeks after this, lie left the house in his ordinary stateof health.

Such, then, is the contrast which delirium tremens andinflammation of the brain sometimes exhibit, as regards theamount of phosphates excreted.The excretion of the excess of phosphates in these last cases

may be considered as resulting from inflammatory action goingon in the brain, whilst the diminution of the phosphates indelirium tremens is probably caused by the positive hindranceof that process of formation of phosphoric acid, which, in thehealthy state, is continually taking place in the body.The excess of action, or the want of action, of the so-called

vital gas, may, possibly, ultimately be proved by the balance,not only to be traceable by its effect on the nervous tissue, butother tissues may give a corresponding result.

Dr. MAYO inquired, whether it had been ascertained, in thecases detailed, if the quantity of phosphoric acid found in theurine had been influenced by the quantity of opium given.

Dr. BENCE JoNEs replied, that we knew that opium had atendency to diminish the quantity of urine secreted; but hewas not aware that it diminished the quantity of the saltsfound in that fluid. It would seem, indeed, from the thirdcase, in which no opium was given, that it was not an agent inhindering the quantity of phosphoric acid.

Dr. F. CHAMBERS inquired if there were any easy and shortmode of detecting the quantity of phosphoric acid in the urine.Dr. BENCE JONES was unacquainted with any easier mode

than that by the balance.

British & American Medical Journals.I INCONTINENCE OF URINE IN CHILDREN.

IN a former number of THE LANCET, it was suggested thatthe most successful method of counteracting this troublesomeaffection, was to prevent the child from lying on its back-aremedy not very easily applied. Dr. R. CHAMBERS makes

some observations on the subject in a late number of the

155

Provincial t/oMi’Hft .which may be usefully referred to. Hesays-"No fluids are to be taken within three hours of going to

bed. The bladder is to be emptied immediately before goingto bed; and, in about three hours after, the patient is tobeawoke, and. the. contents. of the bladder are to be againevacuated. A blister is to be applied occasionally to thesacrum: this answers a double purpose; it acts as a stimulantto-the* bladder, and it prevents the patient from sleeping onhis. back, and thus keeps the urine from gravitating to themost irritable part of the bladder-its trigone. To restore ,the tone of the- bladder, he gives, a combination of equal parts oftiuture. of cantharides, and the muriated tincture of iron, in I,doses of twenty drops thrice a day; and in some cases he usesthe cold dash to the genitals, or the cold shower-bath. i

** There is, Irov4everi at this. time, in: the hospital, a gtrl, aged seventeeu,,,vILo has-been the subject of the disease from ’,infancy, and in whom the above treatment only produced atemporary- alleviation; the case is one of unusual , severity -Mtd obstinacy, and has resisted every effort towards its re- imovals As the girl was rendered incompetent of undertaking Ia situation, and had become a burden to her friends, he feltunivilling to dismiss her till he had exhausted every resource.On rejecting upon the case, it occurred to him that if hecould render a portion of the urethra excessively tender, thepassage of the urine over it during sleep would awake her,and that, by breaking: through the habit, eventually-the diseasemay.be cured. With this object, he had the orifice of theurethra cauterized with the nitrate of silver. It is noweleven days since the -operation- was performed, aad up to thepresent date, there is no return of the incontinence." - ’

METHOD OF SUPPRESSING HEMORRHAGE FROM THE NOSE. ’

Mr. OKE, in the same Journal, details two cases, in whichthe following simple, though perhaps not very novel method,of arresting nasal hemorrhage, was successfully applied,-

" When, then, the haemorrhage continues to be so profuseas to peril the life of the patient, let the lesser finger be in-troduced up the nostril, and pressed upon its base and sidestill the bleeding is stopped. Having kept up the pressurefor a few minutes, a small compact dossil of lint, madewet with cold water, and rolled upon powdered alum, (if athand,) is to be carried up to the point which had been feompressed with the finger, and held there- by the same pressure;after this, other little compresses of the same kind are to besuccessively laid on by the handle of a teaspoon, or some suchmeausj- till the roof of the nostril is - made to supply thepressure of the finger."The same gentleman suggests

A NEW METHOD OF AYPLYING THE LIGATURE IN CASES

OF UTERINE POLYPUS.

The instruments are the same in principle, although moresimple in construction, than those already in use."The instruments are to consist of three metal tubas, two

of which are to, be of the length, shape, and size of a numbereight male catheter, except that their sides are to be Hastened,and that there be no rings at their lower ends. The curvedextremities are to be rounded, each having an oi-ifice in thecentre,-with smooth edges, and large enough to admit a strongligature. The third is a stouter tube of the same diameter, i

eight inches in length, and straight to within an inch of itsupper end, which is to be slightly bent and bulbed. A short Itransverse bar is to cross its lower end, at about an inch from ithe extremity.

"-Mod<< of application.-The two curved canulae, containinga- well-oiled ligature, and exactly fitted together at their flatsides, are to be introduced into the vagina, with the concavesurface to the pubes, their curved ends being directed to the Ianterior part of the stem of the polypus, by the- forefinger of ithe left hand. An assistant takes charge of the left tube, Iand the ligature being reflected, and held between his fingerand the canula, lie keeps the instrument fixed in its positionby pressing it steadily against the arch of the pubes. Theright canula, with the ligature lying loose in the tube, is car-ried round the stem of the polypus, and brought again intoposition under the arch of the pubes, at the left side of itsfellow. The canulae are now to be cautiously withdrawn, bydepressing their handles towards the abdomen, and as theirpoints are quitting the vagina, the ligature is to be caughtbetween the finger and thumb, and held tense till thecanulae are completely clear of it; it is then, by means of ahooked wire, to be drawn through the third tube at its bulb

end, which it guides to the root of the polypus. Ilavingascertained that no part of the os uteri is included within thenoose, and the bulb of the tube being turned to the polypus,the ligature is tightened, and secured upon the cross at thefoot of the instrument.

"The advantages of this method of tying uterine polypi are- first, that it establishes a fixed point for the ligature, closeto the os uteri, and which was scarcely attainable by anyformer method, on account of the unsteadiness and mucosityof the surface of the polypus. Second, the length and curveof the canulae, by which the ligature can readily be slippedround the root of the polypus by the second canula, from thefixed point established by the first: Third, the curves of thecaatdae!! taking the course of the pelvic outlet, give a freedomto the operation, of which, by the means hitherto employed,:it has been comparatively deprived. And, lastly, there utalse an advantage in tae bend and bulb of the third tube; the,former allows a direct action to the ligature, the latter pre-sent, in great measure, all danger of the uterus or vaginabeing injured by any incautious movement of the patient."

THE EMPLOYTMENT OF THE INSANE.

The following satisfactory observations are from the reportof Dr. RAY, in the American Journal of Insanity, to which wehave already, on one or two occasions; referred. The writer,

here alludes to the asylums of Great Britain, but reports in

equally favourable terms of those of France and Germany.la. the former, an improvement much required is. of modern.,date."The employment of the patients in some form of useful

labour is practised in all the institutions I visited, and in someto all! extent quite unparalleled, I apprehend, in thiseountry.It is stated by the metropolitan commissioners, that -at theWakefield Asylum, 120 out of 208 male patients, and 135 outof-190 female patients, were employed in various ways, aad inseveral more, I should think the- proportion of labouring pa-tients-was equally large. At the last-named institution, I wasshown piles of fancy articles made by the female patients,sufficient, with similar acciunulatians at Hanwell, to set up arespectable shop in Broadway. Such exhibitions were fre-quent,-especially in asylums situated in the manufacturingdistricts, and in passing through their workshops, I often-,thought that a stranger would-require farther proof before hecould believe that he. was not rather within the walls of a.factory than of ’a hospital for the insane. At Belfast, for in-stance, it was quite a sight to behold the number of old womenspinning flax with their little foot-wheels, and the rows ofelooms at which a set of cheerful-looking men were makingevery kind’and quality of linen. No factory presents a sceneof busier activity than is daily witnessed in some of the Englishestablisluments for the insane. In one room may be seen a

party making mats; in another, a corps of basket-makers areplying the osiers into fanciful or useful forms; farther on is Stknot of shoe-makers, and in the building across the court, a,joiner’s shop gives employment to those who have a fancy foredge-tools. The blacksmith, the mason, the painter, theweaver, may also find their representatives within the sameinstitution, and in the Surrey, where almost everybody seemedto be doing something, I observed a couple of men very de-murely knitting stockings. Agricultural labour, I found, wasa favourite kind of employment, and the insufficiency of theland a frequent source of complaint :’

"BLASPHEMIES OF TIIE QUACKS.

" The following is a specimen of a description of self-re-commendation resorted to by this fraternity to ingratiatethemselves with nervous’ persons inclined to religious me-lancholy:&mdash;

"‘ And when that day shall arrive, which shall summon meto an eternal world, to render an account of the time andtalent with which my God has honoured me, may I be foundclothed in that perfect i-obe of righteousness in which aloneI can appear before God. Then may I hear the Judge of allthe earth say, ’Well done, good and faithful servant, enterthou into the joy of thy Lord.’ Matt. xxv. 25.’" "

" This, we can assure our readers, is decent compared withsome of the allusions and quotations to be found in the dis-gusting productions advertised so freely in our newspapers., Pious ejaculations, religious exhortations, and texts of Scrip-ture, are found mixed up in the same page with the most de-testable details and the most pointed obscenities; while mockappeals to conscience are accompanied by suggestions of themost flagrant indelicacy."&mdash;Idem.