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that her condition was somewhat unusual as occurring in anunmarried woman. In most respects, the operation, he said,was analogous to several which had been performed in the hos-pital. The womb in this case, however, lay very low down,and the mucous membrane of the vagina was more than usuallyabundant. This is the fifth case of the kind we have had

lately, he observed, and all the previous ones have made goodrecoveries. "You will observe that in this instance I haveconfined myself to the common interrupted suture, instead ofthe quill. I believe that this suture is quite as efficacious asthe quill suture. In the last operation, you will remember Iemployed two quill sutures and one interrupted, and as every-thing turned out favourably, I have this time used all stitches.In course of time, the parts lose their tense condition, the peri-nseum becoming modified by the stretching it undergoes.However, my friend Mr. Baker Brown, of St. Mary’s, hassuggested that I am in the habit of closing the parts too exten-sively, and that it is advantageous for certain purposes to whichthese parts are applied by women not too far advanced in lifethat this should be kept in view. The previous cases will ofcourse remain as they are, but acting upon the hint, I haveaccordingly, in this operation, borne the suggestion in mind."The operation of this day week has made the eighth done

by Mr. Fergusson within a few months, and the seven previoushave turned out well. It is one now becoming of a verycommon character.

NEURALGIA THE EFFECT OF A BADLY-UNITED FRACTURE.

A CASE of some interest was brought into the theatre ofGuy’s Hospital on the 18th inst., which could not be treated inany other way than surgically. A healthy, stout lad, a sailorby occupation, about four months ago, while at sea, fracturedhis right humerus about its middle. The fracture was set insome Spanish port where the vessel happened to be, but sobadly as to produce union with much deformity, and the pro-jection of the broken and sharp ends of the bone anteriorly,which so pressed upon the radial nerve as to cause very severepain along its entire course down to the hand. This had re-sisted every kind of treatment; and as the union of the frac-ture was now very firm and solid, Mr. Cock thought he wouldcut down to the bony projection, and remove as much as hecould with a pair of strong forceps. This was done underchloroform, and two pieces of bone cut off. As anticipated,the pain entirely disappeared, and the lad will no doubt makea good recovery, but still with a very imperfect arm.

TWO CASES OF CANCER OF THE LIP.

ONE of these was in an old man aged seventy-three, who hadbeen an inmate of the Cancer Hospital with a large cauliflowergrowth, involving nearly the whole of the lower lip, of sixyears’ duration. Four years ago it was removed by a surgeonin Berkshire, and reappeared two years after. The upper partof the lip is ulcerated, but healthy-looking, and the surroundingparts look red and inflamed. Latterly his health has beenfailing, but this appeared to us, when we saw him, (July 7th,)to be due more to old age than the disease. The powderedsulphate of iron was sprinkled over the ulcerated surface byMr. Cooke, with good results so far. Dr. Knox pointed outto us in this man the remarkable development of the risoriusSantorini, which, as our readers are aware, is the insertion ofthe platysma myoides muscle into the angles of the mouth.A second case of cancer of the lip, at the same hospital, in a

man aged fifty, had existed for four years. The ulceration wasextensive, involving the whole of the lower half of the orbicu-laris oris muscle, and commenced in the form of a pimple. Alotion of the sulphate of copper was here being used. Dupuytren’scaustic, which recently cured a case of cancer of the lip in thishospital, had been ineffectual in this man. It is composed ofninety-five grains of calomel and five of arsenic.

RESECTION OF THE ELBOW.

WE again saw this operation performed on the 28th of July,at Guy’s Hospital, by Mr. Cooper Foster, on a little boy, whoseright elbow was a typical example of scrofulous disease, fromthe form of the swelling, the number of fistulous openings, andeven some sinuses which were present. Chloroform beinggiven, the lad was turned over on his face, and, by means ofan H incision, the diseased joint removed with cutting forceps.There was a good deal of oozing at first, but it soon subsided.The disease had been existing for some months, and the armreally looked so bad that amputation might have been enter-

tained ; but the ulcerated state of the skin which was presentwas solely due to the effects of counter-irritants. He has goneon well since the operation. We would remark, that this wasa very suitable case for the single long incision, as it wouldhave traversed healthy skin, whereas the two incisions formingthe H went through the inflamed parts.

Medical Societies.NORTH LONDON MEDICAL SOCIETY.

MR. MILTON read a paper on the

TREATMENT OF GONORRHOEA. WITHOUT SPECIFIC MEDICINES.

Having stated the necessity which exists for basing all deci.sions as to the value of medicines on written cases only, forexamining carefully the properties of one remedy at a time tillits true value has been ascertained, the author proceeded togive the result of his inquiries into the action of certain cura-tive measures. All cases having been rejected which were nottraced to their termination, it was found, on careful analysis,that the antiphlogistic plan of treatment did not appear to exertany material influence over the course of the disease; thatwaiting as many days, with the same amount of rest and lowdiet, was equally serviceable. Local bleeding, to whateverextent it was carried, was not found to produce any real abate-ment of the symptoms; it only made the patient more languidand indifferent. Aperients and purgatives, with injections,were about equal to specifics, as were also injections of nitrateof silver, used without medicines: a combination of theseformed a useful, but not a certain, plan of treatment. Thechloride of zinc, in whatever way used, was not superior to thenitrate of silver: injections of either used alone could not berelied on; but it was denied that any proofs had been foundthat either produced stricture or orchitis, except, perhaps, in avery limited number of cases. The preparations of potass,with nitrate of silver injections, were the most certain remedy.Mr. Langston Parker, Mr. Henry Thompson, and many others,had spoken very highly of them. The author separated im-provements in the management of known remedies from use-less introductions, which, having no superiority, only encum-bered the Pharmacopoeia.

Reviews and Notices of Books.Observations on Medical Education in the Presidency of

Madras. By T. F. FERNANDEZ, M.D., F.R.C.S.THE author of this pamphlet was requested by the Major-

General commanding Jaulnah to report upon a new code ofmedical regulations for Madras, and he has embodied some ofhis leading opinions and suggestions in the paper under notice.The apothecaries and dressers attached to the medical offi-

cers in India are a very meritorious, industrious, and faithfulclass of public servants, but it would seem by the author’saccount that they are, generally speaking, deficient in prac-tical acquirements." Unaccustomed to observe the group of symptoms which

constitute an individual disease, and to compare together theliving phenomena with the descriptions of authors whose de-lineations are most true to nature, they are often at a loss torecognise its distinctive characteristics, and fail to identify itby name. They have but a small idea of the manual dexterityto apply a bandage with neatness and facility. If they dress acommon sore, they mop the surface so as to destroy the finepellicle which covers the incipient granulations of a cicatrisingwound, so that it will take twice the proper time to heal.They seldom know the form of dressing, or the medicinal appli-cation best suited to the kind of ulcer. As surgical assistantsthey have neither expertness in manipulation, lightness of hand,or presence of mind; but are clumsy, and cannot find their

hands to render useful assistance in operations, because theyhave been unused to the management of injuries, and the adap-tation of surgical apparatus. Even as dispensers of medicine

patients often complain of the anomalous appearances of their. draughts; and now and then an ominous circular comes to hand

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from the Medical Board, enjoining us to write our prescriptionsin English, or to return to some -old-ftshioiied name, when weprescribe an active drug. In cases of emergency, which requirecoolness, steadiness, and resolution, for the calm considerationof what should be done, common difficulties disarm them, andtheir faculties are dispersed into a state of confusion, becausethey have not been habituated to face such occasions of danger.Or the predicament may vary: signals of import in approachingdanger, which ought to stimulate to vigilance, of which promptadvantage should be taken, escape their coguizance, and thusan opportunity of protracting, perhaps of saving, life is lost.Yet we cannot attribute blame to their remissness, nor supine-ness, much less unconcemedness, because they have had solittle to deal in their lives with the stern realities of disease.But the predicament may be worse than all this. You shallfind a class of men, void of all diffidence, insensible to dangeror to fear,—of whom there are not a few,-who, with a wantonpresumption and indifference to the onus of responsibility, willbe betrayed into undertaking operations which they have nonotion of contriving; you shall tind one ready to attempt theCaesarian section, pausing at no risk, and deaf to cries of pain,with a most faint conception of the steps to be observed in theprocedure; and after it is over, beset with no more compunc-tions than dread of meeting the apparitions of the sufferers."—pp. 10-12.

Clinical instruction is the obvious corrective for this serious

evil, which the author would accomplish by means of specialmedical tutors, selected from those Indian students who haveheaded the classes of their respective years, in the manner ourhouse-surgeons are selected here."The preceptor, having sprung from their own class, and

being conversant with their habits of thinking, would overcomethe reserve of his pupils, whose subjection of mind disposesthem to distrust their own powers in the presence of theirsuperiors, which also, in a manner, limits their quickness ofperception. By his ready knowledge of the vernacular, thetutor would further set them at their ease, and, with an in-stinctive apprehension of their difficulties, as often as theymight run astray, point out the proper course to surmountthem. The tutor should attend the medical and surgicallec-tures, in order to imbibe the doctrines of the professors, thathe may instil them with additional emphasis upon the class, bydemonstration upon apposite cases. Precept and practicewould then go hand in hand. He should teach the student theproper method of examining a patient, so as to elicit a full ac-count of his present condition, and direct him in drawing up astatement of the case; in fact, to transfer the problem to paperby an intelligible and orderly arrangement of symptoms. Be-ginning with slight deviations from health or local ailments,the pupil would advance by degrees to acute cases, with a largf-rassemblage of symptoms. He would trace, with the tutor’sassistance, the varied play of the functions in disease, to theirnatural causes, analyze complex cases, and be led on to detectthe conflicting agencies at work. For each condition he wouldbe guided to the scientific means of relief, restorative or coun-teractin;, as the case might be. In less conspicuous complaintsthe tutor would search out the more latent signs, try everylink of the chain which connects the symptoms, and, in theirnatural course, turn all practical opportunities to account thatwould educate the senses, and instruct his pupil to interpretthe book of Nature. For want of proper furtherance in earlypractical education, we observe how often medical men, notinitiated in the cypher of hysterical complaints, will puzzleover a case for half an hour, in which the flltw in the symptomsis as clear as daylight; and, after all, remain in doubt them-selves, although they have quite settled the convictions of thepatient. Not before it is too late her ghastly looks attractcompassion, and marked general, if not discriminating, notice."- pp. 13-1;.

Dr. Fernandez justly remarks-" The superiority of knowledge derived from personal obser-

vation, and the relief afforded to its acquisition by colloquialexplanations, tend to excite the mind to curiosity. Each stepso gained is felt by the pupil as a real advance, and facilitatesfurther progress. Above all other, practical knowledge begetsself-confidence and promptitude, sharpens apprehension,quickens the faculties of conception, comparison, and inference,improves the judgment, and qualifies for executive duties."-p. 15.

There are some other suggestions which deserve the atten-tion of the H. E.I. C. S. , with which we close our extracts :-

" I have lying before me a list of ninety-six drugs, in moreor less common use, supplied from the vegetable kingdom,which are either the product of the East Indies or adjacentislands, or could be grown here. Of these but an insignificantpart are purchased in this country, the bulk of them beingsupplied by the Apothecaries’ Company. I would solicit par.ticular attention to a few of the consequences. Take the leavesof hyoscyamus, grown at Serhampore and elsewhere, for mereexample. It is first exported to England as an article of mer-chandize, and when presented in the drug mart, bought by theApothecaries’ Corporation. In their hands it is ground topo-wder, reduced to extract, ur infused for tincture. The hyos-cyamus, in these forms, is re-imported by us. But mark! tinc.tures are all made with exciseable spirits, the duty on which isexceedingly heavy in England. Of course in India, spirits ofwine is subject to no such levy, and, moreover, it can bedis·tilled at a fraction of the cost it is at home. The toddy of thecommon palm tree, which a poor cooley may drink ad tibitumfor the twelfth part of an anna,, yields in the copper stills ofour maritime provinces, or in the interior in earthen vessels,one-eighth part of proof spirits. We know that Ceylon exportsabove i,000,000 gallons of arrack, at 10d. or Is. per gallon;perhaps the very best may reach Is. 6d. (twelve annas.) Not-withstanding, all our sulphuric ether, spirits of nitre, chloro.form, and other medical spirits, are distilled at home. Again,the mineral kingdom of India may be made equally productive.I am sure that there are not finer crystals of sulphate of iron inexistence than can be bought in the common bazaar of this veryplace. The professor of chemistry could very readily furnishan excellent substitute for quinine at a third of the cost, which,if plentifully distributed, medical officers would employ in lieuof it; so that an ounce of quinine would suffice for a pound thatis expended now. In short, most, if not all, the chemical com.pounds which enter into the Pharmacopœia, should be preparedin the laboratory at Madras. The work would be no morethan is actually performed at the Veterinary School of Alfort,near Paris, for the use of that establishment. And most, ifnot all, medical plants might be grown to perfection on theNeilgherry Hilis, to supply the whole of India from its medicalherbarium, were the ground occupied, the head gardeners’houses built thereon, aud Paxton and Hooker requestad tomake the appointments. But I ha,ve trespassed too long onthe reader’s patience, and have said enough to indicate that,by better management in the department of medical stores, a,very large saving would accrue. "-pp. 24—20.

Since this paper was written, Lord Canning has introduceda plantation of cinchona trees imported from Gera; and thenew medical code, which is full of admirable provisions for theregulation of the medical department of the service, contains alarge list of medicines purchasable in India. We should thinkthe active principles of chirayta and of the piper nigra might besubstituted for general use instead of quinine, for native hos-pitals.The plantations of tea in Assam are increasing very rapidly

in extent, and their produce is equal in quality to that f110many part of China.

____ _______

Vocal Gy?n2zastic.3; or, a Guide for Stammerers, and for P2cbdicSpeakers and others who suffer from certain minor Peezeliari-ties of Utterance. With an Appendix of Cases, &c. By G.F. URLiNG. 12mo. pp. 89. London : John Churchill.Tars is a very small work, but it contains much really-im-

portant and novel information, not only upon stammering, butalso upon the physiology of speech. The style is clear andlucid, the directions plain and unmistakable, and the method(as proved by the cases reported) successful. Mr. Urling isnot a medical man, but he is evidently under good medicalinfluence; and he writes and acts in the most friendly spiritto the profession, as will be evident when we say that he hasbeen advised to publish (see the Preface) by Dr. Gull of Guy’sHospital, and Dr. Radcliffe of Westminster Hospital.

OTTO On the Detection of Poisons. From the German; withNotes and Aciditions, by WILLIAM ELDEBHOST, M. D. 8vo,pp. 178. NewYork : H. Baillière, 290, Broadway, and 219,Regent-street, London.

Tttis work is written in a clear ,and logical style, the sub.ject of which it treats, the application of chemistry to toxi-

225

oology) is of vital importance to the medical student, who,perplexed by a multiplicity of subjects, will, doubtless, be

only too glad to find, within a moderate compass, the essentialpoints to which his attention should be directed ; and the prac-titioner, anxious to have the important facts of toxicologicalchemistry always in his mind, with such practical applicationas he requires, will find a desideratum in this book.

Foreign Department.DB. CHURCHILL’S TREATMENT OF rHTIIISIS, BEFORE THE

ACADEMY OF MEDICINE OF PARIS.

DR. CHURCHIU (who lately endeavoured to institute experi-ments at the Consumption Hospital, Brompton) read beforethe Academy of Medicine of Paris, on July 21st, 1857, a paperon the Immediate Cause of, and on a Specific Remedy for,Pulmonary Consumption. The summing-up runs as follows:—"In June, 1856, the Academy did me the honour of accept-

ing sealed papers, in which were contained my first ideas re-specting the specific treatment of the tubercular diathesis. Iwas. at that period anxious, to collect a greater number of factsillustrating my discovery; but ill-health obliged me to suspendmy labours, and the results which I now bring forward aremuch less numerous than I could have wished. I have treatedin all 35 cases of phthisis, both in the second and third stage-viz., with softening tubercles, or with vomicas. Out of thatnumber, 9 recovered; with 8, the physical signs disappeared;11 were much improved; 14 died; and 1 is now under treat-ment.

" From these facts, and the views contained in my paper, Imay frame the following statementsThe immediate cause of tuberculosis, or at least an essential

adjunct of it, is the decrease in the organism of the phosphoruswhich therein exists in a state capable of oxydation.The specific remedy of this complaint consists in the employ-

ment of a preparation of phosphorus which presents two cha-racters-the first, of being fit for immediate assimilation; andthe second, to be at the same time in the lowest possible stateof oxydation. The hypophosphites of soda and lime are thesalts which have hitherto presented these two characters in themost complete manner. Either of these salts, administered indoses varying from ten to forty-five grains per diem, may beused in the treatment of phthisis. The highest dose which Ihave given to adults has been iifteen grains day."These preparations have a direct action on the tubercular

diathesis, and dispel with a really wonderful rapidity all thesymptoms which characterize the disease. When the morbid

deposit which is the special result of the dyscrasia is recent,when the softening is only incipient, and does not take placetoo rapidly, the tubercles are removed by absorption, and dis-

appear without leaving any trace. When the deposit is ofolder date, and the softening has reached a somewhat highdegree, the breaking-down process may continue in spite ofthe treatment, and the issue of the case will depend on thepathological peculiarities of the lesion, on its extent, and espe-cially on the presence or absence of complications. I have e ’made numerous attempts to modify the local mischief by meansof inhalations of several substances, but I have obtained nofavourable results, except such as were owing to the generaltreatment."The physiological effects which I have observed during the

administration of the phosphites of soda, lime, potash, andammonia prove that these salts have a double action. On theone hand, they immediately increase the principle (whicheverit may be) which constitutes nervous power; and they presentus, on the other hand, very efficient blood-generating agents,far superior to any hitherto known. These preparationspossess in the highest degree all the therapeutical propertiesattributed by former observers to phosphorus, and are devoidof the dangers which have almost consigned this substance tooblivion. It cannot be doubted but that hypophosphorouspreparations will henceforth rank foremost in therapeutics."

ETHER ’l,’erSU8 CHLOROFORM.

PROFESSOR BARRIER, of Lyons, has puhlished in the GazetteMeclicale de Lyon, August 15th, 1857, an able article, tvllereinhe contends that ether should be used in preference to chloro-

form as an anaesthetic. He concludes by propounding the fol-lowing opinions :-

"1. When death is instantaneous, it must be the result ofan idiosyncrasy which contributes in rendering the prostrationof the nervous system more rapid and complete ; hence fatalsyncope.

2. As ether acts less powerfully and quickly than chloroform,it exposes patients less frequently to that instantaneous pros-tration.

3. If asphyxia can be looked upon as one of the causes ofdeath under anfcsthetics, it may be easily prevented, when itarises from an imperfect mode of inhalation, which does notallow a sufficient amount of air to enter the chest.

4. If death, on the other hand, is the consequence of pro-tracted anaesthesia, the latter is of course the more dangerousin proportion to the rapidity of action of the anesthetic agent.

5. Ether is to be preferred to chloroform, because it is lessdangerous, and that the few disadvantages attributed to thatagent are of too secondary a character to cause its use to begiven up in operative surgery." "

That the data as to the number of deaths by chloroform mustbe very incomplete, is proved by a fact stated in the above-mentioned article. i11. Barrier states that five deaths frominhalations of chloroform have to his knowledge taken place atLyons, and that one only has been published.

RESULTS OF THE OPERATIONS OF TRACHEOTOMY PERFORMED

FOR CROUP AT THE CHILDREN’S HOSPITAL, PARIS, DURIi‘1fx‘

THE YEAR 1856.

WE find in the Bulletin de Tlt6rapeutique (May 30th, 1857,)an extremely instructive table respecting tracheotomy in croup,taken from the thesis of M. Andre, late house-physician(interne) of the Children’s Hospital :-

From this table it appears that many successful cases oftracheotomy have been observed, as nearly one-third of thepatients recovered. The most notable success has been ob-tained with children from nine to nine years and a half old,and then with those children who were from five to six yearsold. The least satisfactory results were observed from fifteenmonths to two years, for here we have six operations and sixdeaths. All the children under two years are to be found inthe column of deaths; and all those who died, except two,were just a little more than two years old. M. André thinksthat these facts mav be explained by the greater amount ofresistance with the older children, both as regards the diseaseand the operation. He also conceives that debilitating means,-as leeches, blisters, &c., should be sparingly used so as to hus-band the strength for tracheotomy.

FOnGED DIPLOMAS.—T’itUam Stuart Farqnharson, whowas recently detected as a pretended priest, and the author ofa forgery on the Bucks and Oxen Bank, at Banbury, has justbeen sentenced, at the Oxford Assizes, to twct’v,- years’ penal6!’?Mn’e, having pleaded guilty to the forgery. The prisonerhad run a long and successful career as a forger, principally offoreign medical degrees, for each of which he obtained, withgreat facility and rapidity, the sum of .840; this sum includedan Inaugural Dissertation on any subject, which the intendedrecipient was supposed to defend before the heads of the univer-sity. The prisoner, Farquharson, was formerly in the 2nd Somer-set Militia, but had to resign in consequence of the colonel dis-covering some of his disreputable antecedents; subsequently,howeBer, he contrived to get into the Lincoln and the Elthorneregiments, obtaining his outfits by forged acceptances. He wasthe author of " The Pleasures of Home," a goodly octavo; andhe may, in fact, be lcoked upon as a very clever knave.