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which, judging from the symptoms, had with every probabilit3been set up some years previously by inflammatory actionrendered pressure unavailing.The distention increasing in a short time, so much so as tc

cause great discomfort, she determined, with my concurrenceto undergo the median section. The operation was undertakerby Mr. Lane; but on making the incision, the operator discovered the adhesions of the sac to be so extensive and scfirm from their old standing, that it was found inexpedient, 0]rather impossible, to attempt the removal of any portion ojthe tumour. The hardened tumour previously recognised a,an undeveloped cyst, and actually a double cyst, as well asthe old large cyst, were punctured and emptied. The woundin the abdomen was closed up, and the patient recovered fromthe operation.About twelve months from this period, Mr. Lane, in con.

junction with me, made trial of puncturing the cyst, and leav-ing a bougie introduced into it, so as to produce suppurativeinflammation, a plan recommended by some authors. Thisattempt, however, turned out unfortunate; the patient, afterabove a week’s continuance of the plan, having becomeattacked by a low, or typhoid fever, partaking the charactersof that type, which follows on the introduction of pus intothe system-the latter an occurrence not improbable in thepresent case. Death ensued at the end of a fortnight.From the circumstances of this case, it is clear that it was

unsuccessful, not from the failure of my mode of treatment,but by reason of its being not in any way amenable to it, andI may add, to any other. The presence of the dense unde.veloped cyst, and the numerous strong adhesions of the largefluctuating one, negatived the probability of any good attend-ing the application of pressure.

Mercurials had been fully tried under her former medicalattendant; and in spite of these, and of the leeching in theearlier stages, when pain occurred in the region of the ovary,the extension of the morbid adhesions seems to have gone onunchecked. For ten years, according to her account, she hadbeen occasionally subject to pains in the lower part of the ab-domen-the only symptom of ovaritis noticed; for that lesionwas probably present. During this lapse of time, the recurringattacks of inflammation of the ovary tended to the develop.ment of further disease in that organ, ending eventually inthe formation of the cysts, which, by their enlargement, be-came perceptible two years antecedent to my seeing her.

Oxford—square Tan 1840

ON THE

INHALATION OF NITRATE OF SILVER ANDOTHER MEDICINAL AGENTS.

BY THOMAS K. CHAMBERS, M.D., F.R.C.P.

WniLE treating diseases in those parts of the mucous mem-branes which are sufficiently exposed to sight and touch, forthe immediate application of remedial agents, there are fewto whom the wish has not occurred that equal facilities wereafforded of directly influencing the deeper-seated continuationsof the same fabric. The powerful remedies which restore sorapidly to health the conjunctiva and the fauces, would pro-bably act with equal quickness and success on the stomach orthe bronchi, could we apply them rightly to the right spot, andattack the local disease without passing circuitously throughthe whole system. A mode I have lately adopted of attainingthis end with the most inaccessible mucous surface of all, thepulmonary, though it is clumsy and imperfect, may still befound useful in some obstinate cases where the upper part ofthe air-tubes are principally diseased. The plan is, the inha-lation of a light innocuous powder, which may carry with itthe required substance, either diffused in the air or absorbedin its pores. That which I have found well suited to the pur-pose is the pollen of the gycopodium, or club-moss, whichhas been made to imbibe as much as it would take up of a sa-turated solution of nitrate of silver, or of sulphate of copper,or of the two combined, and then carefully dried, and reducedagain to an impalpable powder..Mr. Squire has made me some,which, in two grains and a half, contains one grain of nitrateof silver, and another, which in five grains contains one ofnitrate of silver and two of sulphate of copper. The patientshould introduce into his mouth, as far as he can withoutchoking, a well-dried glass funnel, and draw in his breathstrongly, whilst he himself, or a second party, dusts thepowder in a dense cloud into the large end with a nurserypuff-ball. If the dust be raised by an attendant, the patientcan indicate the moment he inspires by raising his hand. Toobviate the necessity for withdrawing the funnel during ex-

r piration, to prevent the dust being blown about the room,, an apparatus may be used with a double valve and a closed

powder-box, which allows the dust to pass inwards only; but) the employment of metal makes the machine less agreeable, than the more awkward but cleaner-looking and less formid-

able glass.There is usually some coughing excited by the dusty vehicle,

) but not of such moment as to prevent the immediate’ repetition of the experiment. This is certainly an inconve-F nience, but it seems a much minor one than those which at-

tend the introduction of a sponge into the larynx, as has beenrecommended. The spasm excited by this is distressing to the

l operator and painful to the patient, and prevents its employ-i ment in slighter cases where the remedy appears to both as

bad as the disease. Moreover, the operation is a very difficult- one, requiring a rapid accuracy, a spirited tenderness of touch,- as the artists call it, which is the lot of few, and is seldom re-

tained at that period of life when the intellect is most ma-! tured, and when the brush, the burin, and the scalpel, are’ handled with more judgment indeed, but with less elegance

and delicacy.Hill-street, Berkeley-square, March, 1849.

Reviews.

The ELements of Materia Medica and Therapeutics. By JONA-THAN PFREIRA, M.D., F.R.S. & L.S., &c. Third edition, en-larged and improved. Vol. I. London: Longmans & Co.1849. 8vo, bound in cloth. pp. 89T.

IT is seldom necessary to appropriate any lengthened spaceto reviewing a new edition of a work, however copious. It isan old but trite maxim, that " good wine needs no bush;" andthe fact of any literary production running through several(well authenticated) editions, is proof sufficient that it needsnot public attention to be called to it by the press for its me-rits to be recognised. The great work of Dr. Pereira appears,however, to have been greatly augmented in the edition be-fore us.

" Several portions (says the author in his preface) have beenentirely re-written, some have been curtailed, others en-

larged, and every part has been carefully corrected, and, it isbelieved, much improved.... Numerous recent discoveriesin natural history, chemistry, physiology, and practical medi-cine, relating to materia medica, have been embodied in thisedition ... Notices of many of the less frequently employedmedicinal substances have also been added, so that the worknow embraces an account of the chief medicinal agents usedin the civilized world, and maybe said to form an Encyclopædiaof Materia Medica . . . In the list of inorganic bodies manyagents have been retained which are usually classed amongstinorganic substances; for example, those metallic salts, whichconsist of an inorganic metallic oxide and an organic acid....The only exception to this mode of proceeding will be foundin the case of the cyanides, the account of which will followthat of hydrocyanic acid, as their medicinal properties are forthe most part derived from the cyanogen which they contain.... In the present condition a new physiological classifica-tion of the articles composing the ’ Materia Medica’ has beenattempted,-with what success the author leaves others tojudge."The present edition is illustrated with various cuts, and the

headings of the different articles, as should be the case in allDictionaries, are in bold and conspicuous type. Dr. Pereira’s is,beyond dispute, the best work on Materia Medica. Weshall hail the appearance of the second .part of it with

pleasure: the first is, in every respect, a splendid volume.

Medical Societies.

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

TUESDAY, MARCH 27, 1849.—DR. ADDISON, PRESIDENT.

CASE OF CERVICAL PARAPLEG’A IN AN INFANT. By HENRYDAVIES, M.D., Physician to the British Lying-in Hos-pital, &c.

ELIZA A. B-, aged twelve months and a half, had beenweaned three months, without trouble, and had cut the twolower central incisors. On the 17th of November she had

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been particularly lively all the day, had taken her usualexercise in the baby-jumper, and was put into her bed, in theevening, apparently in good health. When the nurse went tobed she appeared restless, and crawled into the nurse’s bedfrom her own, which was close beside it. At five o’clock inthe morning she sat up in bed, and ate a finger-biscuit. Athalf-past five she uttered a peculiar cry, for which someDalby’s carminative was given, without relief. The childshivered slightly. At six o’clock she was put into a warmbath, and had a dose of castor oil. At eight o’clock she tooka basin of bread-and-milk. At ten o’clock she was violentlysick, turned cold, and looked blue about the mouth, nose, andeyes. She was now put into a second warm bath, when sheappeared to lose the entire use of her limbs, and her counte-nance became vacant. From this time she lay prostrate.When seen by the author, on the evening of the 18th ofNovember, she was perfectly conscious, her head was cool,and the temperature of the surface generally natural, thepupils contracting under the influence of light; pulse mode-rately frequent, small, and languid; tongue slightly coated.The upper extremities were devoid of all power of motion orsensation, even from pinching or pricking with a pin; but thelower extremities were drawn up on her feet being tickled.Nothing unnatural was detected in the course of the spinalcolumn, or any other part. Two leeches had been appliedbehind the ears; a blister was put between the shoulders; aperi-ents and a saline mixture, with ammonia, were given. Duringthe five weeks that the child lived, no change took place inthe paralytic symptoms, and she remained perfectly consciousto within a few hours of her death. She was much weakenedby diarrhoaa, which set in on the 9th of December, and fromthat time she became emaciated, and was restless and feverish,while the lateral incisors came through the gums. Duringthe five weeks she cut six teeth. The body was examinedtwenty-four hours after death. The dura mater, as well as aportion of the brain, was torn in opening the head, and aboutan ounce and a half of sanguineous fluid escaped. The ves-sels on the surface of the brain were somewhat fuller thannatural; the cerebrum itself healthy; the cerebellum andmedulla oblongata, as well as the nerves at the base, wereparticularly firm. The medulla spinalis was equally firm, itsinvesting membrane tough, and vessels tinged. There was nofluid in the ventricles of the brain, and no lesion was disco-vered either in the brain or in the spinal cord. The visceraof the thorax and abdomen were generally healthy in appear-ance. The author remarks, that paralysis, coming on sud-denly, not preceded or accompanied by any apparent diseaseof the brain, is by no means uncommon in children betweenthe first and tenth year. In all cases, he believes, the pre-disposing cause is the process of dentition. The excitingcause has, in the majority of cases, appeared to be some de-rangement of the digestive organs. But in the case now re-lated, which is peculiar, from the sense of feeling, as well asthe power of motion, being lost, lie believes the excitingcause was the succession of shocks received by the spinalcord through the use of the baby-jumper. He adduces somearguments and quotations from authors in support of hisopinion; and in an appendix gives a brief account of fourother cases of paralysis in children.

Dr. M. HALL said he had been as deeply interested in listen-ing to the details which had just been read to the Society,as he was to the case of Mr. Dunn, read at the last meeting,and which, if he might make a suggestion, he would adviseto be published, divested of its commentary. The authorhad evidently felt all the difficulty, as well as all the im.portance, of an accurate diagnosis in cases of paralysis; andthe question had for many years been an object of specialinvestigation with himself. He would endeavour very brieflyto state to the Society some of the conclusions at which hehad been enabled to arrive. In the first place, paralysis hadbeen for ages aptly distinguished from hemiplegia and para-plegia, the former being, generally, not always, cerebral inits origin, the latter spinal. But besides hemiplegia andparaplegia, there are cases of partial paralysis, arising fromaffection of the nerve of the part itself-an affection mostfrequently seen in the face; so that we have cerebral, spinal;and what might be termed neural paralysis. But all casesof partial paralysis are not affections of this nerve merely;for we may have partial hemiplegia, hemiplegia limited to theeyelid, to the face, to the arm, to the leg, &c. We may also,he believed, have partial paraplegia, or paraplegia limited tcan arm or leg; though of this he was not so certain. Thieremark led him to the case before the Society-a case oiparalysis of the two arms, and, as he understood, of the twcarms only, the legs being unaffected. What could its nature

have been ? It is almost impossible to imagine disease ofthe spinal marrow so situated as to induce paraplegia of bothsuperior extremities, without involving in its effects the partssituated below. Paralysis of one arm, like paralysis of oneleg, might arise from disease of the vertebra, so situated asto involve the immediately adjacent portion of the spinalmarrow, or the origin, roots, or trunk of the brachial nerve.But how such disease could affect both brachial nerves, with-out involving the intervening substance of the spinal marrow,and so inducing paraplegia of the inferior extremities, it isdifficult to imagine. He concluded, therefore, that Dr.Davies’s case could not arise from disease of the vertebra,or it could not be one of half-paraplegia, using this term inits ordinary acceptation. What, then, was its intimatenature ? There are two cases, one of which the given case mayhave been: the first is effusion at the base of the brain, slowlyencroaching on the spinal canal, and compressing the rootsof each brachial plexus. But this case is slow in its acces-sion, and the case before us was more or less sudden. Thesecond is of a totally different character. Sudden attacks ofparalysis, of an arm, of a leg, or of both arm and leg of thesame side, in children, are not very uncommon. They aregenerally preceded or accompanied by spasmodic or convul-sive affection. He thought they were to be traced to dental,gastric, or intestinal irritation, acting, in a reflex manner, onthe muscular system, and especially on the muscles of theneck, whence the veins of this region became compressed, andthe nervous centres congested with blood, and there were comaand general convulsion. If such a state of things may occa-sionally leave one arm paralyzed, it seems not difficult toimagine that in rare cases both arms may suffer the same lossof power. Both arms are frequently convulsed; why shouldthey not be equally paralyzed ? yet, he repeated, this is rare.Before he concluded these remarks, he said he felt compelledto revert, in a few words, to the observations which fell froma Fellow of this Society (Mr. Streeter) at their last meeting.Mr. Streeter animadverted on an experiment of M. Flourens,and on that gentleman’s experiments on the nervous system,or centres generally, in terms, in his idea, neither just nor re-spectful. [See THE LANCET, p. 361.] It was not necessary, hebelieved, for him to defend his absent friend. But this hewould say: no day of his life passed without his feeling mostkeenly how much he owed to the secretary of the Institute.His career of investigation in the nervous system, both of itsphysiology and its pathology, had been greatly promoted bythe labours of M. Flourens, many of whose experiments hehad had occasion to verify and confirm, and the whole seriesof which he believed to be amongst the most logical and im-

portant in physiology, and to present a model of investigationin that science. 1B1. Flourens is a most honourable person, amost conscientious experimenter, and a most accurate ob-server ; and a more beautiful and valuable work than his" Researches" did not, in his firm opinion, exist in the scienceof medicine.Here Dr. M. Hall was interrupted by the President.Dr. M. HALL added that the interruption was, he doubted

not, perfectly proper; but that the remarks of a former even-ing, on which he had commented, should have been inter-rupted in like manner.The PRESIDENT observed, that he was not aware of having

allowed any improper observations to be made on thatoccasion.Mr. STREETER said, that Dr. Hall had misapprehended the

remarks he had made at the last meeting; he had said no oneword disparaging to the character of M. Flourens. He hadcalled into question the accuracy and value of the deductionswhich M. Flourens had drawn from his experiments. He(Mr. Streeter) had yet to learn that any man was above criti-cism in that Society, and protested against such an assumption.

Dr. HALL said, that no one in that Society could hear Mr.Streeter’s explanation with greater satisfaction than himself.

. Dr. HALL has forwarded to us the following note, which wehere insert, to make the subject complete.

NOTE BY DR. MARSHALL HALL.

I To the Editor of THE LANCET.; SiB,—I shall be obliged to you if you will append the fol-i lowing note to your account of the discussion at the Medico-, Chirurgical Society on the 27th.i When interrupted by the President, I was about to add! these observations:-First, I should have quoted the followingF extract from Mr. Streeter’s remarks-" Read the biography of, that wonderful hen, from which M. Flourens removed the

cerebral hemispheres, and watched daily for ten long months,"