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his descriptions are concise, and the general rules of practicelaid down, good. Perhaps Mr. Lizars deemed it unnecessary,in a book chiefly devoted to operative surgery, to describe

symptoms particularly, and for that reason has been so brief,in general, in their enumeration, and in some cases has omittedany mention of them. Tims, the operation for aneurism of theabdominal aorta is mentioned, but none of its distinctive signsgiven: in the account of popliteal aneurism he narrates thegeneral signs of aneurism, but the modes of operating in allother aneurisms are described without any reference to the

signs of each in particular. The symptoms, moreover, of theseveral dislocations and fractures are very summarily dis-cussed. Nevertheless, it behoves students to acquaint them-selves with such matters in other than a general manner; toexamine minutely into symptoms, in order to draw an accuratediagnosis. We must admit, however, that from the generalcompass of his treatise, embracing, as it does, all the topics ofsurgery, including diseases of the eye and their operations,some things must necessarily be dwelt on less than they de-serve by the author, in order to keep within the bounds of asingle volume. To this cause, along with the character of thework, which keeps operative surgery chiefly in view, must weattribute the apparent defects and omissions of many thingswhich we should look for in a work on surgery in general.The author seems to possess little faith in the use of com-

pression for the cure of aneurism ; for all mention of themethod is embraced in a few lines, and in that short spaceit meets with no favour: lithotrity, likewise, is little valued.To express the relations of parts to each other, and to the

centre, Mr. Lizars adopts a nomenclature which was proposedsome years ago, but which has been but little employed,although often tending to prevent circumlocution; we allude,to the words distad and proximad, to express remoteness ornearness to the heart respectively; tibiad and fibulad, towardsthe tibia or the fibula, in each case. These words will sound

strange to those unaccustomed to them, but they have nofurther objection, since their meaning is readily understood.Itis unnecessary here to make extracts from the treatise before

us, inasmuch as it does not pretend to discuss knotty points insurgical pathology, or to throw any new light upon it, but togive only the ordinary rules of the science, and those bywhich we are to be guided in practice; and, on the subject ofOperations, as before observed, we are not dazzled by anynew devices, but have placed before us those plans now gene-rally practised; and all this is done, for the most part, in aclear and commendable manner.From what we have said, our opinion of the work before us

may be gathered-viz., that it is one which may well fulfilone indication named in the dedication, that of furnishing a" remembrancer to the practitioner;" and to a student attend-ing lectures in which the principles of the science of surgeryare fully unfolded, or to one who possesses a good treatise onthose principles, it will serve as a useful guide and text book.We have already expressed a high opinion of the value ofthe engravings illustrating this system of surgery, which willcontribute much to its utility: to this we may add, that thetype is very good and clear, and the work, thus well got up, isproduced at so reasonable a price, as to place its purchase inthe power of every student, who may add it, with advantage,to his surgical library.

’

Medical Societies.

WESTMINSTER MEDICAL SOCIETY.

SATURDAY, NOVEMBER 20.—DR. WEBSTER, PRESIDENT.

THE NEW-LETHEON AGENT. IDr. SNOw made some remarks respecting chloroform. He

Said that this agent, which had been introduced by Dr. Simp-Son, to be inhaled instead of ether, was preferable to thehtter in some respects,- although it was impossible that any- I

thing could be more efficient than ether, as it was capable oftotally preventing the pain in every operation in which itmight be properly applied. He considered that the action ofchloroform on the nervous system was identical with that ofether; by regulating the proportion of vapour in the air, hehad produced the same effects on animals by both agents;chloroform, however, had the advantage of being less pungent,and, therefore, less care was required in graduating its firstadmission to the lungs; it was readily inhaled, and producedits effects with great rapidity, and the quantity of it consumedwas curiously small when compared with ether. He hadadministered it on Thursday, in an amputation of the breastperformed by Mr. Tatum, at St. George’s Hospital. He gaveit with his usual apparatus, the water-bath being 55°, and thequantity of vapour in the air inhaled not more than ten percent. by measure, yet the patient was ready for the operationto begin in less than a minute, and it was performed withoutthe least sign of pain, being equal to the best cases of etheri-zation. The patient recovered her consciousness, as mighthave been expected from narcotism by ether to the samedegree, and she was going on well. Only one fluid drachm ofthe material was used, although about ten fluid drachms ofether would probably have been used in the same operation.He (Dr. Snow) had inhaled it until he became unconscious,and was very sick afterwards, as on the only occasion on whichhe inhaled ether to the same extent. When the full effectsof ether could be induced quickly, there was no preliminaryexcitement, and as the new agent produced its effects very

speedily, excitement previous to insensibility could probablybe altogether avoided in its use. The chloroform placed onthe table had been given to him by Mr. Bullock, the chemist;it had been rectified from chloride of calcium; he (Dr. Snow)found its boiling point to be 1400; he was not aware that theelastic force of its vapour, at other temperatures, had beenascertained; but, from some experiments that he had made, itseemed to follow a ratio very similar to those for ether-vapourand vapour of water; he had ascertained the quantity ofvapour of chloroform that air would hold in solution, atvarious temperatures, and it was shown in a table, of whichthe following is a copy:-

The quantity of this vapour in the air the patient inhaled atordinary temperatures was only about a quarter as much bymeasure as there would be of ether,-being, however, nearlytwice as heavy; there was nearly half as much by weight.Now, on account of the small space it occupied, it only ex-cluded the air to a quarter the amount that ether-vapour did,and therefore interfered but little with the natural process ofrespiration ; the patient, indeed, could take in nearly theusual amount of oxygen without quickening or enlarging therespiratory movements. It was to be observed that tempera-ture exerted a great influence over the quantity of this vapour

that air would take up, and thus an elevation of little morethan fifteen degrees in the warmth of the apartment would

double the amount of it which the patient would inhale in agiven time, if no means were taken to regulate the evapora-tion. Dr. Simpson recommended the chloroform to be inhaledfrom a sponge or handkerchief, and this simple means wasefficient; but he (Dr. Snow) preferred to use an apparatus, as,without it, more of the vapour was blown away by the warmbreath of the patient than was inhaled. The strength of thevapour could not be regulated; it could not even be knownwhen it was all expended, and no exact observations couldbe collected. The chloroform was of easier application thanether, on account of its quicker action; but for the samereason, greater care was required in its use to avoid accident.Dr. FREDERICK Bum said that he had seen the chloroform

administered that day in two operations, by Mr. Phillips, atthe Westminster Hospital; it was perfectly successful, andthe patients recovered their consciousness very quickly.In answer to a question,-Dr. MURPHY said, that he had only employed the inhalation

of ether in extraordinary cases, because he found that itcaused excitement both before and after insensibility, and he

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dreaded the occurrence of haemorrhage at such times. Didchloroform cause a similar excitement?

Dr. SNOw considered the excitement to arise from the slow-ness with which ether was administered, which might benecessary or not, as the patient could bear it; the chloroform,by its more rapid action, would not cause this so much, butthe return to consciousness, after taking it, presented thesame symptoms as were exhibited after the use of ether. Heconsidered that two practitioners should be present in a caseof labour if inhalation were to be practised, as one person’sattention should be devoted to the inhalation only. Patientswould not die from convulsions while inhaling, but from con-tinuing to inhale after collapse had appeared.

Dr. MURPHY had known ether to cause spasms resemblingthe access of puerperal convulsions.

Dr. COLEY read a paperON DIPHTHERITE.

He was called, on October the 16th, to a child, aged oneyear and ten months, who was breathing with great difficultyfrom an effusion of a foetid false membrane over the fauces;this attack followed a sore throat, subsequent to measles, whichhad suddenly retired. Dr. Coley applied nitric acid to thefalse membrane over the fauces, and shortly afterwards, thebreathing being more difficult, and stertor commencing,tracheotomy was performed with immediate relief; the childwas also ordered a grain of calomel every two hours. On Oct.20th the fauces were found quite free from false membranes,and the breathing continued easy, but was rendered difficultagain by withdrawing the canula the next day and closing thewound by a bandage. The calomel was discontinued thatevening; the child sunk into a state of exhaustion, which in-creased, notwithstanding the administration of ammonia, bark,and wine, and the child expired on the evening of the 22nd.The examination of the body showed an entire absence of in-flammation, but there was effusion into the pleura and peri-cardium. The child took about twenty-four grains of calomelin all. He considered the little patient to have died fromexhaustion. The discussion of the case principally turnedupon the advisability of giving calomel in such large quantitiesto young children; some gentlemen objected strongly to it,while others considered the plan as most useful.Mr. HIRD had found great benefit in cases of low inflamma-

tion from the use of alkalies, as liquor potassaej he approvedof tracheotomy as superior to laryngotomy, and its perform-ance by the knife rather than by a trocar.

Dr. WEBSTER said that at the Congres Sciéntifique in Paris,this summer, M. Bretonneau spoke highly of the use ofhydrochloric acid in this disease, also of alum applied locally.He recommended calomel, in the same way as it was exhi-bited by Dr. Coley.

Dr. COLEY had performed tracheotomy several times inthe country, but, from a prejudice against it, it had been post-poned till a late period. He had found it very unsuccessfulfrom previous extension of the disease to the lungs.

Dr. MuRPHY observed that these cases generally occurredin persons of very reduced constitutions, and asked whattreatment would prevent it. He thought the operationincreased the risk of the child. The case was of an erysipe-latous nature, and he should suppose the treatment oughtto be bark and wine.

Dr. WEBSTER considered that calomel might be given inlarge doses in dry weather, but in warm weather, with a south-west wind, and the barometer low, the child would not bearso much.

Dr. AYRES considered that children bore large single dosesof calomel well, but not repeated doses. Salivation diminishedthe amount of fibrine in the blood; hence, probably, its influ-ence on these diseases.Dr. COLEY said that a second case of diphtherite occurred in

the same family, which was cured by a smaller amount ofcalomel, about fourteen or fifteen grains, he supposed; thiscase was treated early in its course. In answer to a question,he said, that he did not give tartar emetic, as the child was notequal to bear it.Mr. HIRD said, that diphtherite was epidemic at present.

It was a disease allied to erysipelas. He objected to calomel,as not controlling disease of mucous membranes so much asthose of other tissues.

Dr. KING mentioned having given calomel in one-scrupledoses in cases of cholera, at Bilston, in 1832, with great advan-tage. Some patients took two or three ounces, and recovered.A All,,1113ER stated that the same good effect had not followed

_ similar use of calomel during the cholera in Ireland ; on the

contrary, large doses appeared to be injurious.

British and American Medical Journals.SINGULAR MALFORMATION OF THE UTERUS; SPONTANEOUS RUPTURE

IN THE EARLY MONTHS OF PREGNANCY.

The following is an outline of the facts of this singular case,466pied by a cotemporary from the Buffalo Medical Journal : -

" A girl, seventeen years of age, was seized with colic-likepains, and died soon after. She had previously enjoyed goodhealth, and had menstruated regularly until three monthsbefore the attack."On post-mortem examination the following appearances

were observed:-The cavity of the abdomen was filled withcoagulated blood, surrounding a fostus of the third or fourthmonth. The uterus was ruptured along its right side, fromthe fundus to near the neck. The left ovary and Fallopiantube were entirely wanting. The right ovary and Fallopiantube were present, but the latter entered the uterus near theneck, and the ovary was correspondingly lower than natural."The uterus appeared to be developed to the size of the

third or fourth month of gestation. The placenta was attachednear the fundus upon the left side. On the side of the uteruswhere the rupture occurred, the walls of the organ were ex-tremely thin. At the seat of the rupture there seemed to benothing but the peritonaeum; and in the immediate neigh-bourhood the friability was such that it was readily torn bythe fingers with slight force. On the left side, the walls wereof the usual thickness, but did not present the common fibrousappearance. 0;! exmnÙzat1"on of the neck, no apedure could befound, nor was there any trace of an os tizzcce. The neck re-sembled a tendon in appearance, but was of less deusity. ’1’7I(’1’ewas no commum’cation between the cavity of the uterus and the1’agina."

ON IRRITABLE ULCER OF THE RECTUM, AND ITS TREATMENT.

Mr. B. COOPER, in a lecture in the }’Iedical Gazette, describesvery clearly this painful form of disease-painful to the

patient, and sometimes not less so by its obstinacy to thepractitioner. Speaking of irritable ulcer, he says,-

" Such a condition of ulcer not unfrequently attacks therectum, under the form of a narrow elongated fissure runningalong one of the folds of the mucous membrane, near to theorifice of the anus. The edges of the fissure are free fromany callosity, and it bears a strong resemblance to the crackswhich frequently affect the lips."The most usual situation for the ulcer, as far as my expe-

rience goes, is at the posterior aspect of the rectum in themesial line, although 1 have sometimes found it on the sideof the bowel. The ulcer may involve merely the edge of theverge of the anus, or extend a considerable way up the intes-tine, but may always be detected by passing the finger intothe rectum, when the nature of the sore is readily appreciatedby the extreme pain which the patient experiences directlythe finger comes in contact with the fissure." The symptoms of the disease are highly characteristic: a

burning pain is experienced during the act of defalcation,which continues for a considerable time after each evacua-tion. During the intervals the patient enjoys comparativeease, but still occasionally suffers from heat and lancinatingpain about the anus, but nothing to be compared to the agonyproduced by the passage of the faeces over the ulcerated Sur-face and through the sphincter, and which is commonly moreor less in a state of spasmodic contraction." The bowels are in these cases generally constipated; now

this symptom involves the question as to whether this consti-pation is not produced rather by the unwillingness of thepatient to evacuate his bowels than from any derangement offunction ? The best, and, indeed, the only positive, evidenceof this disease, is the introduction of the finger into therectum, which, on being withdrawo, will be marked with astreak of blood, and lead to the discovery of the size and posi-tion of the ulcer.

" If the disease be allowed to remain for any considerabletime, the patient’s health becomes seriously affected by theconstant suffering, and from the countenaice one might sup-pose that the disease was of a malignant character. The

digestive functions become deranged; the appetite fails; theslightest exertion, such as the act of coughing or blowing thenose, is sufficient to excite the pain; and any excess of diet is

sure to aggravate all the symptoms.

I " Although this distressing affection will not yield to theremedies recommended in irritable ulcers in other parts ofthe body, its treatment is fortunately very simple. It con-