INCISED WOUND OF THE PATELLA.

204

pillow, the inflammatory symptoms were subdued by means of leeches and evaporating lotions. I afterwards applied a bandage

scribed

ever.

the

an

Aquœ Am-

anodyne draught.

Acet. iss;; Mist. Camph. j; cac. gtt. xxx; et Tinct. Hyos. cathartic draught to be taken mon.

; Vin. Ipe3j; and a

from the foot to above the knee, putting a early next slight compress on the patella. The same morning. Oct. 16. No effect from the cathartic position of the body was strictly observed for nearly a month, when the union was draught. Slept a little last night, and seems complete. Mr. P. can now, three months easier to-day, but stilt complains of much since the accident, walk nearly as well as pain in the knee, which is much swollen;

integuments are tense, red, and shining; pulse 100, but soft; countenance less flush-

ed ; tongue still furred; thirst urgent; urine still scanty; skin hot, harsh, and dry. ReINCISED WOUND OF THE PATELLA. peated the saline antimonial solution of yesterday, until the bowels were affected; a bolus in the evening. Ext. Hyosciam. To the Editor of THE LANCET. j;Pulv. Ipecac. gr. ij ;Potass. Nitrat. gr. v SiR,—The following case of severe wound lit. bolus. Two drachms of laudanum to of the knee may not be unacceptable to yow be added to each poultice, as yesterday; rereaders. I am, Sir, your obedient servant, new the poultice four times in the twentyJ. L. M CARTHY, M.D. four hours. The wound 17. Considerably better. Macroom, Oct. 26, 1835. much cleaner, and beginning to suppurate On the 15th of the present month, I was freely. His diet had been until to-day en. called to see John Lordan, setat. 22, a car. tirely limited to diluent drinks. Repet. penter, a stout healthy young man, who; catap. c. Tinet. Opii ut hein, et sum. haust. three days previous to my visit, fell, while in ex Olei Ric. j et Tinct. Opii gtt. xvi, c. Aq. his workshop, when his knee came in con- Cinnam. iss. At night an anodyne bolus of tact with an " inch-and-a-quarter dubbing Extract of Henbane gr. xvi, and Ipecac. chisel," which was lying with its sharp end gr. i,j. 18. Much better; one copious stool from upwards. The instrument cut through the integuments and membranes over the the draught yesterday. Slept well; inflampatella, and penetrated that bone to the mation of the knee entirely abated, except depth of one line. Much tumefaction im- immediately at the edges of the wound; to mediately arose about the joint, extending which spot the pain is also confined. The to some distance up the thigh and down the cut is granulating, and the patient can, for leg. The pain was so extreme as to prevent the first time since the accident, flex the sleep for two nights, during which he had joint without pain. Repet. cataplas. sine His tinct. opii. Omit olea. Broth and vegetables also some delirium and headache. countenance was flushed; the tongue co- for dinner. 20. Allowed to get out of bed, and to omit vered with a white fur, moist at the edges, but brown and dry in the centre, towards the poultices. Apply lint to the wound, Pulse 122, full, and moistened with a solution of sulph. of zinc its posterior part. hounding; no alvine evacuation for fifty and comp. spt. of lavender. On the 24th inst. he was able to return to his work. hours; urine scanty and high-coloured. This case illustrates two things in the I removed a piece of adhesive plaster that covered the wound, which was about treatment of wounds. First, the advantage The edges of combining anodynes, both locally and an inch and a half in length. retracted for the space of a line and a half, generally, with antiphlogistic remedies; and, the interval being filled with a rusty, brown- secondly, the mischievous effects that freish matter, and almost dry. He had been quently follow the application of the resin-

to the dispensary in this town on the day on which the accident occurred, when the ad-

ous

adhesive

plaster

to recent

wounds.

hesive plaster was applied. I bled him to syncope, applied a poultice of oatmeal and linseed to the knee, and prescribed a bolus of calomel, jalap, scammony, camphor, &c., and in two hours after, a tablespoonful of the following mixture to be repeated every hour, until the bowels and stomach were affected : — Antimonii et Potassæ Tarfrat. gr.ij; Magnesiœ, Sulphat. 3.i;; Aquce xij. The medicine operated once by vomiting and twice by stool, and copi.. ously. There still remained so much tension of the system, that I again bled him to the amount of twenty ounces, and pre-

A Theoretical and Practical Treatise on the Diseases, of the Skin. By P. RAYFR, M.D. 2nd Edition, entirely remodelled. With an Atlas, in 4to, of Twenty-six Copper Plates, containing Four Hundred Figures, coloured. Bailliere. London. 1835. 8vo.

pp. 1835. THE structure of the skin, and the interesting results of Breschet’s researches into its intimate tissue, were fully described in our

pages

a

few weeks since. We then dcferrcd

205

entering into the question of its complicated racy and utility at their just value. Artifipathology, with the intention of recurring cial classifications, like alphabetical arrangeto the subject in a notice of the work now ments, gradually give way as a science adbefore us. It was shown that the skin was vances. Things which men only wish to essentially constituted of the interlaced distinguish, or know by name, by rote, or fibrous derma, covered by a scaly epider- very cursorily, they wish to find with the mis, penetrated with innumerable sentient least possible degree of trouble; and this papillae, arranged in ridges visible through they can generally do by fixing on one elethe epidermis-that the perspiration is se- ment, or organ, to the entire neglect of all creted by glands in the derma, and con- the rest. An artificial classifier may classify veyed through spiral ducts to the surface,- mankind by the colour of their eyes or their and that the epidermis is a mixture of dried hair alone. He may arrange animals acThe cording to their length, or the number of mucous scales and colouring matter. examination of the sebaceous crypts, hair, their teeth; while he who wishes to make nails, and all other cutaneous appendages, one vital law, or type of being, to illustrate was deferred to the appearance of Breschet’s another, would take every organ, every second memoir, and are recalled here to fix function, and the entire economy of aniattention on the subtle anatomy and phy. mals, into account, in an arrangement, at siology of the corporeal envelope by which once admitting of practical application, and the inward parts of man and animals are philosophical in its principle. Dr. Rayer’s bound together, and separated from, while classification, founded on that of Willan, is they communicate with, the external world. confined too exclusively to the anatomical But where there are many structures and element,-anatomical, in the vulgar sense of organs exercising harmoniously their seve- the word ; where nothing further is included ral faculties,-where the physiological en- than the careless scalpel or the eye detects. dowments are multiplied-the pathology, It consequently leads often to absurd results. which is but a disturbance, a deterioration What more deplorable change can be conor transformation, of the natural condition, ceived than that which takes variola from will also be multiplex. And such is the among the exanthemata, to place it by the case with the skin, which presents in dis- side of acne ? Dr. Rayer’s classification is, ease the most diversified appearances and ’, happily, the least important, at the same trains of phenomena; interesting from their time that it is the worst, part of his work. own peculiarities, and their connection with The great merit of Dr. Rayer’s book is its the internal organs, and the facility they afford for constant observation. What dif- graphic style, the fulness of its descrip4 ferences are there between erysipelas, scar- tions, and the practical character of the latina, and urticaria; variola, acne, and im- contents. It is a comprehensive natural petigo ; herpes, scabies, and sudamina ? Yet history of cuticular diseases ; and while it these belong to the three several groups, displays considerable learning and research, - exanthemata, pustulse, vesiculae, of Dr. is evidently written from direct and personal observation. The therapeutic departRayer. ment is very copiously treated; it embraces The manner of grouping cutaneous disa list of, and often offers judicious criticisms eases, so as to make them throw the greatthe numerous drugs and agents which est light on each other, has always pre. on, have been found most successful in treatsented, like several departments of natural ment ; and is valuable, because it has been history, the greatest difficulty to systematic drawn up by a physician in extensive pracwriters. Willan and Alibert’s arrangements who is not disagreeably sceptical nor tice, diverge most; as a difference from Willan credulous. formed at least one principle in the ar- unboundedly The former edition of the work has been rangement of the facetious and ingenious physician, professing materia medica at the remodelled in the present edition in several Ecole de Mgdecine, and cutaneous pathology respects. In the first place the fundamenat the Hopital St. Louis. The learned and tal doctrines of the author in pathology able Biett still adheres to the main features have been changed, and, in our opinion, for of Willan’s classification; and few men in the better. He formerly treated cutaneous Europe are better able to estimate its accu- diseases as purely local affections; that this

206

imperfect view is not now held is very ob- f (the formation of the atlas) would certainly vious. He remarks :1 have prevented me from undertaking it the assistance of Mr. James Young without " It is long since the study and description of those diseases which appear on the of I Paisley, who, to perfect familiarity with exterior of the- body with characteristicthe diseases of the skin, adds the talent of symptoms, were detached from general pa- seizing, to admiration, the different appearthology, and it is impossible to deny that theances they exhibit, and of representing these history of these diseases has been more fully and satisfactorily given by the writers whowith great fidelity." It is only just to add, from our own have made them objects of their peculiar consideration. Nevertheless, it must be knowledge, that the engagement of Mr. allowed, that many serious inconveniences in this work, and the friendship of would arise from completely abstracting Young Dr. are highly creditable to both Rayer, from the this study that of other morbid conditions of the economy. It would, parties. above all, be a grave error to separate The translation has been made into En. certain cutaneous eruptions from lesions of glish by an accomplished scholar, and preother systems, when both derive their origin sents all the ease and perspicuity of an from the same cause. To attempt to isolate original work. the venereal eruptions, for example, from the other symptoms of syphilitic infection, exostoses, periostoses, nocturnal pains in the bones and joints &c.,—would evidently be A Treatise on the Functional and Structural arbitrarily to disconnect the different orders with numerous nu2nerous Liver, 4-c. Changes of the Lit’er, &c.; with of systems of one and the same disease. Cases exhibiting tlae the Inval?Îon, Invasion, Symptoms, These venereal eruptions have, farther, so Progress, and Treatment of Hepatic Disintimate a relationship with the primary ease in India. CONWELL, By W. E. E. CoNWEi., symptoms to which they generally succeed, M. R. R. I. 1. A., M.D., &c. London : Duncan. it even becomes imperative on us to 8vo. pp. Svo. 1835. pp. 531. 531. 1835. include both under the same general head OuR brethren in India, separated from us by of investigation. " Certain diseases, such as the eruptive so many leagues, and exposed to a climate fevers, produced by infection of the whole whose ravages annually decimate their ranks, system, although they indeed exhibit them- and which fosters the indolence natural to selves on the exterior of the body at deter- men whose existence is assured, always minate periods in peculiar and characteristic claim our attention, and possess our heartiest symptoms, are, to all intents and purposes, of which are sympathy, in their literary tasks. We feel, general diseases, the -effects occasionally felt with far greater violence by besides, a high degree of interest in the reother systems than by the skin. In some sult of their investigations; because, beset cases, indeed, in variola, rubeob, scarlatina, as are with difficulties, it still lies in they &c., no eruption ever makes its appearance, their power to solve some of the most imand the skin then continues entirely a the effects to of the portant problems connected with the etiocontagion. stranger Who does not know, moreover, that these logy of disease. But we know, that to endiseases impress or modify the constitution title our opinions to weight on the banks of so deeply, that it generally becomes for ever the Ganges, they must be strictly impartial, after unsusceptible of being influenced by the cause which produces them ?"-p. xxix. that we must withhold eulogium from pre" tensions which are poorly supported,-from The literature and history of skin books which contribute nothing whatever are considered in detail; and if much criti- to the advancement of medical knowledge. Under neither of these categories does the cal sagacity or novelty is not displayed, a sober judgment never forsakes the writer. work of Dr. Conwell precisely fall; but cerAgain. The Atlas is now rendered so tainly a very lax principle presided over its valuable and extensive, as to form the promi- composition. What induced the Doctor to nent distinction of the work. No atlas re- write a thick octavo on hepatic disease ? presenting cutaneous diseases rivals it in Was it the simple fact of his having resided merit. And we are happy in being able twenty years in India ? We hope he can to add that the plates were executed by a answer these questions to the satisfaction of British artist, who in Paris added to his origi- his own conscience. In summing up the nal pursuit the study of medicine. "The diffi- amount of his literary sins, the 232 abridged culties," says M. Rayer, "inseparable from cases which he has transcribed from his

that

,

diseases

’

the

accomplishment

of such an

enterprise rougli note-boo],-,

can

alone, in

our

opinion,