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ON DIFFUSED INFLAMMATION OF THE CELLULAR TISSUE OF THE SCROTUM.
359 In this detail we notice some points slightly at variance seat of the disease, in an enormously swollen and diswith modern accounts of the action of hemlock when taken tended condition; it is of a dull, reddish hue in appearance, in a toxical dose; yet, on the whole, I am disposed to prefer tense, shining, and void of rugae; on handling it, the tempePlato’s account. Thus, according to it, asphyxia seems not to rature is rather below what it ordinarily is, with an emphyhave supervened at all, or, at least, only immediately before sematous crackling on pressure being made. At the postedeath; though some modern writers assert that asphyxia occurs rior and most pendulous part, dark, ash-coloured spots, varyearly. Yet again, the open mouth and eyes favour the supposi- ing in size, may be observed, these conveying conclusive evition of a death due to interruption of the respiratory process.* dence of the gangrenous state of the cellular tissue, occasioned It is a very remarkable fact, and one of great physiological by infiltrated serum compressing the circulation. The system interest and importance, that while goats and sheep browse deeply sympathizes in these results, the countenance becomes harmlessly on hemlock, and horses suffer only slightly from depressed and anxious, the pulse weak and labouring, the the use of it, the cow, the wolf, and the dog, are poisoned by a tongue coated with a brownish fur. I mentioned, in an earlier moderate quantity of it. Surely some very valuable facts con- part of this paper, the great rapidity with which gangrenous nected with digestion might be elicited from an investigation symptoms come on; the consequences are, that the case is of the causes of these different effects of hemlock on the seldom presented to the notice of the surgeon until serious stomachs and systems of different animals, some of them of the mischief has taken place; it then behoves him to treat "
it as if under the poisonous influence of infiltrated urine. In fact, the appearances and symptoms are very similar to that condition when in the scrotum, and are followed by extensive sloughing, oftentimes leaving the testes, with the tunica vaginalis, entirely denuded of their natural coverings. The prognosis in these cases is favourable, provided the person has strength of constitution sufficient to bear up against the shock, and the subsequent exhaustion which attends the result. The treatment required must be decisive. If seen in the earliest stage, fomentations, with saline medicines, might check its progress, also the application of nitrate of silver is highly calculated to be of service for this object; but if neglected until a later period, free incisions through the skin and cellular membrane must be made without delay, to enable the morbid serosity to escape, and to favour a loosening of the sloughing tissues. Poultices and fomentations are now necessary, with a strict attention to the preservation of cleanliness. A solution of the chloride of soda or lime is required to neutralize the excessive foetor, and the strength of the patient is to be supported by tonics and ammonia, aided by nourishing diet. ON Two of these formidable but very interesting cases have DIFFUSED INFLAMMATION OF THE CELLULAR been admitted under my care, as patients at the Bloomsbury TISSUE OF THE SCROTUM. Dispensary, within these last twelve months, which I beg BY GEORGE L. COOPER, ESQ., F.R.C.S.E., Surgeon to the leave to relate :CASE 1: James Taged fifty-two,by trade amodellerfor Bloomsbury Dispensary. THIS disease is nearly allied, in character and symptoms, to jewellers, was admitted March 1st, 1846, a patient at the Dispensary. On visiting him, I found him to be erysipelas, appearing, in its earliest stage, under the class ex- Bloomsbury stout man, of sanguineous temperament. States that up to anthema, with a like tendency to spread from its primary athe last month he has always enjoyed good health; but has seat of attack to the neighbouring parts, exciting an effusion of serum in the subcutaneous cellular membrane, and in cases drank freely, principally spirits. About six weeks previous of severity, a similar disposition to end in mortification. Under to his present illness, he went to Ireland on business, where this appellation I proceed to describe two forms of diffused the whisky suited his palate, and he accordingly enjoyed abuninflammation which have occasionally fallen under my notice dance of it. On his return to England, he remained in Man- the one mild and tractable in its nature, the other phleg- chester a few days; but feeling unwell, he left for London in an open third-class carriage. The weather on this day was monous and severe, running, in the course of a few hours, into In the first, or mild form of this disease, bitter cold. Two days after his arrival in London, he coma state of gangrene. the symptoms are ushered in by slight pyrexia, which is soon plained of an uneasiness about the anus; but thinking it followed by an erythematous blush, extending over the groin, might go off, delayed applying for relief. In the course of perinaeum, and scrotum; the last becomes œdematous, hot, twenty-four hours, he found this to increase, as also his scrotum and painful, but speedily yields to a mild, antiphlogistic treat- to be much swollen, when he procured a letter of admission, came under my care. ment, with rest, fomentating, and a farinaceous diet. This and March 1st.—The scrotum is much swollen, deep reddish species of diffused inflammation is usually the result of some local irritation, consequent upon fatigue and exhaustion, and hue, shining, very tense; and the rugæ, quite absent. A sensation is perceived on squeezing it, as if air was may be met with in persons of all ages. In the second and crackling acute form, the progress of the disease is more rapid and in its interstices. The perinseum is also boggy on pressing it. Pulse 80, tremulous, and rather weak; tongue dry and furred; dangerous, showing itself, in the first instance, under appa- bowels open. Incisions were made on each side of the raphe,, but ere hours have rently trifling circumstances; many elapsed also in the perinsæum. Ordered, linseed poultice, and fomenassuming the character of phlegmonous infiltration, and tations to the scrotum and perinasum. Solution of the acetate placing the life of the sufferer in the greatest jeopardy. It is’ of ammonia, one ounce and a half; sesquicarbonate of amseen in persons of intemperate and cachectic habits, who have monia, twenty-four grains; camphor mixture, six ounces, for been subjected to cold and wet, or to any depressing agent of the vital powers. In the earliest stage the patient com-_ a mixture; dose, two tablespoonfuls three times a day. 2nd.—Has passed a restless night; pulse 84, rather weak; plains of a sense of irritation in the situation of the rectum, when an erythema may be observed on the integuments of much serum has escaped. The medicines to be repeated, and these parts, which soon spreads over the neighbouring sur- ten grains of compound ipecacuanha powder at bedtime. 3rd.-The sloughing of the scrotum is extensive; foetor very faces, accompanied by constitutional disturbance; the redness extends along the perinseum, over the scrotum, penis, and1 great; pulse 84; he complains of much debility; bowels open. Ordered, disulphate of quinine, sixteen grains; diluent suleven to the inferior portion of the abdomen, committing,, acid, forty minims; water, half a pound, for a mixture; ravages in its course. Thus, in forty-eight hours, the’ phurictwo tablespoonfuls three times a day. Lotion of chloride perinæum becomes tumid and boggy to the touch, the penis dose, of soda to be applied; the compound ipecacuanha powder reto a with state of cedematous, amounting phymosis, superficial ulcerations, and the scrotum, the principal and worst peated. Diet to be nourishing. 4th.-Was called up last night for retention of urine; the * That is, death occurring, as in strangulation, from privation of oxygen, catheter passed with some difficulty; deeper incisions in the and while the nervous system and the circulation are in comparative vigour. perinseum were made; much foetid serosity escaped. Repeat, When death results from a gradual and simultaneous subsidence of all thee the medicines. vftl powers or organs, the lips, and often the eyes also, are closed, and the 5th.-Has passed a better night; pulse 82; sloughs beginning expression of the countenance tranquil, and even smiling-facts of some to loosen. Repeat the medicines. importance in medico-legal examinations.
genus, and of very nearly related species. Hemlock is a useful sedative. In gastrodynia it acts well combined with the tris-nitrate of bismuth, with nitrate of silver, and the oxide of zinc. In scirrhus and cancer of the pylorus, it is indicated, since while it relieves pain it does not constipate. I have seen it useful also in mesenteric affections of strumous children. In France, they combine it (and, I think, judiciously) with the iodide of iron and with quinine, in cases of scrofula. From one to ten pills, made from about half an ounce of extract of hemlock and one ounce of iodide of iron, are given daily in cases of scirrhous and scrofulous tumours, and in phthisis. In phlegmonous scirrhus, the hemlock is, in France, joined to extract of cinchona. Giacomini, in his celebrated classification, places conium among lymphatico-glandular hyposthenics, and also, from its reducent action on the contractions of the heart, among cardiaco-vascular hypothenics. Bentinck.street, Manchester-square.
same
’
’
,
.
.
f -
t _
360 6th.-Feels comfortable. Repeat the medicines. 8th.—The sloughs are loosening; complains of debility ; pulse 84 and weak. Repeat the medicines. 10th.-Much the same. 12th.—Sloughs have come away. Ordered, sulphate oi zinc lotion. The parts to be supported by a bandage. Appetite good, and is gaining strength. 15th.-Continues to improve. Lotion repeated. From this time, cicatrization took place rapidly.
session, is so diluted, that at the termination of his hospital studies he finds himself all abroad in the matters of The centrifugal power will be chemical decomposition, &c. supplied by this new edition of an old favourite: it is cor-
first
enlarged, to suit the march of improvement, which, during the last seven years, has been so distinctive of a. the English medical schools. When Mr. Meade-in his day very popular private teacher amongst the transpontine April 10th.—Discharged cured. students of the metropolis-originally published his Manual, CASE 2.—Jesse W-, aged fifty-five, by trade a sawyer; no student was required to " get up" the stethoscopic signs of admitted Dec. 27th, 1846 ; of plethoric habit; works hard; disease; microscopic anatomy was scarcely dreamed of; the has drank freely; and does not get nourishing food every of Liebig was unbegotten; and the countenance physiological chemistry Pulse and anxious; day. 78, easily compressed; that on the discoveries of Hall of States Marshall thirst. and unacknowledged. Much credit tongue dry; complains 23rd he was exposed to wet and cold during the day’s work. is due to the editor, for the great labour and care he has In the evening shivered much, and " felt uneasy about the bestowed upon this epitome of medical science; as the power On the following day, he anus, as if he had got piles." of is so fascinating and so natural to all authors, amplification much exertion. returned to his work, but was very unequal to On the 25th, Christmas day, he perceived a redness on the so is the conciseness and concentration shown in this Manual perinseum; kept himself quiet. On the 26th, worked in a the more praiseworthy. We would particularly specify the sawpit the principal part of the day; and in the evening was chapters on toxicology and the practice of physic; we can much worse. On the following day, Sunday, 27th, his wife them to be the concentrated notes of a very diligent called at my house with a letter for the dispensary. From imagine her description, my expectations were fully realized on student of the last session. The visceral anatomy is very visiting him. The scrotum was very cedematous, tense, shining, concisely given; but why omit all notice of the theory of the emphysematous to the touch, quite void of rugae, and of a reflex function ? Surely medical examiners will require their deep reddish hue; at the inferior and posterior parts, dark candidates to have some acquaintance with so important a ash-coloured spots were observable, about the size of a fourpart of physiology. The editor has behaved so well towards penny-piece. The perinæum unsound and boggy on being the stethoscope and the animal chemistry of Liebig, that we pressed; the penis cedematous, with superficial ulcerations, and in a state of phymosis. Incisions were made through regret to have to remind him of this unfortunate omission. the cellular membrane of the scrotum, also of the perinseum ; There is just room for complaint, too, concerning the physiohaemorrhage very slight; much infiltrated serum has escaped, logical chemistry-some two or three subjects remain untogether with foetid air. Ordered, linseed poultice and fomen- noticed, the theory of the formation of dew, &c. Whilst in tations to the parts. Infusion of cascarilla, seven ounces and this suggestive mood, induced by the general excellence of a half; sesquicarbonate of ammonia, twenty-four grains; tincthe work; we would hint at the propriety, when another ture of cardamoms, four drachms, for a mixture; dose, two edition is called for, of a formulary for the doses of medicines tablespoonfuls three times a day. 28th.-Has had no sleep; pulse 90; diarrhoea has been fre- in combination: they are, of course, given separately, but quent during the night; the exudation from the scrotum is students require to know the quantities of each medicine they very great, and extremely offensive. Ordered, chalk mixgive, when it is desirable to combine thef ction of two ture, six ounces; tincture of opium, forty drops, for a mixture; may or more. Diet dose, two tablespoonfuls every four hours. nourishing. We have taken these few exceptions, because the book 29th.-Has slept better last night; diarrhœa is somewhat is but feels the scrotum extenis a good one, and we should like to see it as perfect as very weak; abated, sloughing sively. The last mixture to be repeated. possible. 30th.—Diarrhœa has stopped. The chalk mixture to be omitted, and the cascarilla mixture to be resumed. Braithwaite’s Retrospect of Medicine. Vol. XIV. July31st.-The sloughing continues; pulse 80 ; complains of December, 1846. great debility. All the medicines to be repeated; they were continued onward to the 18th proximo. THE practitioner in medicine is much indebted to Mr. Jan. 1st.—Has passed a good night, and feels better. Braithwaite, for enabling him, without wading through the 2nd.-The sloughs are loosening; infiltrated serum very volunlinous articles of the Quarterlies, or the long speeches of abundant; foetor excessive; bowels regular. projectors and objectors at the various societies, to keep up 4th.-Is much the same. 6th.-A large portion of slough has loosened; he says he his information as to the progress of improvement in his profeels comfortable; pulse 78 and weak. fession. 8th.-Going on well. No man can look over this work without feeling proud of 10th.-Sloughs are coming away both in the scrotum and the profession to which he belongs, and of the men who ornaperinmum; he feels stronger, and sleeps well at night. , 13th.-The whole of the anterior integuments of the ment it. Here are 450 closely-printed pages of concentrated scrotum have sloughed away, leaving the testes quite denuded. information, touching upon 200 subjects, and we dare to affirm 16th.-A large slough in the perinæum has come away; that not half-a-dozen of those pages is without a highly practical suggestion. To reduce ingenuity and hypothesis to appetite good; in fact, could eat more than he gets. 18th.—Is going on well. Ordered, nitrate of silver, one is peculiar to our country, and in this work it ,is degrain; water, an ounce, for a lotion. Poultices to be omitted. practice to see how every new invention, or discovery, or lightful 22nd.-Continues to progress favourably. The parts to be is weighed as to its applicability to the relief of a suggestion, supported by bandage. 26th.-Going on well. Lotion repeated. This treatment the suffering patient. With this book in his hand no man was continued until Feb. 15th, when the scrotum and adjacent need be ignorant of the improvements of the day. We parts were healed. Discharged cured. scarcely know how to select, amongst the numerous articles Keppel-street, Russell-square, March, 1347. of interest, the most interesting. Perhaps the most novel, and the one most likely-should future experience prove its truth-to show itself of signal benefit to the physician in his Reviews. diagnosis, is Mr. Hutchinson’s, on the use of the spirometer. In a paper read before the Royal Medical and Chirurgical Meade’s Manualfor Students. Second Edition. London: Society, by Mr. Hutchinson, he speaks of the difference in the Renshaw. of air respectively drawn in or thrown out of the WE are not amongst those who think this class of books quantity as follows:lungs, injurious. There is a remarkable centrifugal force always 1. Residual air; which is that air remaining in the lungs cannot be expelled by the most violent muscular effort. acting on the student’s sensorium, by which the knowledge that " ’ he has acquired from lectures and large books, during the 2. Reserved air, or that which remains in the lungs after rected and
________
,
"
" ’
it as if under the poisonous influence of infiltrated urine. In fact, the appearances and symptoms are very similar to that condition when in the scrotum, and are followed by extensive sloughing, oftentimes leaving the testes, with the tunica vaginalis, entirely denuded of their natural coverings. The prognosis in these cases is favourable, provided the person has strength of constitution sufficient to bear up against the shock, and the subsequent exhaustion which attends the result. The treatment required must be decisive. If seen in the earliest stage, fomentations, with saline medicines, might check its progress, also the application of nitrate of silver is highly calculated to be of service for this object; but if neglected until a later period, free incisions through the skin and cellular membrane must be made without delay, to enable the morbid serosity to escape, and to favour a loosening of the sloughing tissues. Poultices and fomentations are now necessary, with a strict attention to the preservation of cleanliness. A solution of the chloride of soda or lime is required to neutralize the excessive foetor, and the strength of the patient is to be supported by tonics and ammonia, aided by nourishing diet. ON Two of these formidable but very interesting cases have DIFFUSED INFLAMMATION OF THE CELLULAR been admitted under my care, as patients at the Bloomsbury TISSUE OF THE SCROTUM. Dispensary, within these last twelve months, which I beg BY GEORGE L. COOPER, ESQ., F.R.C.S.E., Surgeon to the leave to relate :CASE 1: James Taged fifty-two,by trade amodellerfor Bloomsbury Dispensary. THIS disease is nearly allied, in character and symptoms, to jewellers, was admitted March 1st, 1846, a patient at the Dispensary. On visiting him, I found him to be erysipelas, appearing, in its earliest stage, under the class ex- Bloomsbury stout man, of sanguineous temperament. States that up to anthema, with a like tendency to spread from its primary athe last month he has always enjoyed good health; but has seat of attack to the neighbouring parts, exciting an effusion of serum in the subcutaneous cellular membrane, and in cases drank freely, principally spirits. About six weeks previous of severity, a similar disposition to end in mortification. Under to his present illness, he went to Ireland on business, where this appellation I proceed to describe two forms of diffused the whisky suited his palate, and he accordingly enjoyed abuninflammation which have occasionally fallen under my notice dance of it. On his return to England, he remained in Man- the one mild and tractable in its nature, the other phleg- chester a few days; but feeling unwell, he left for London in an open third-class carriage. The weather on this day was monous and severe, running, in the course of a few hours, into In the first, or mild form of this disease, bitter cold. Two days after his arrival in London, he coma state of gangrene. the symptoms are ushered in by slight pyrexia, which is soon plained of an uneasiness about the anus; but thinking it followed by an erythematous blush, extending over the groin, might go off, delayed applying for relief. In the course of perinaeum, and scrotum; the last becomes œdematous, hot, twenty-four hours, he found this to increase, as also his scrotum and painful, but speedily yields to a mild, antiphlogistic treat- to be much swollen, when he procured a letter of admission, came under my care. ment, with rest, fomentating, and a farinaceous diet. This and March 1st.—The scrotum is much swollen, deep reddish species of diffused inflammation is usually the result of some local irritation, consequent upon fatigue and exhaustion, and hue, shining, very tense; and the rugæ, quite absent. A sensation is perceived on squeezing it, as if air was may be met with in persons of all ages. In the second and crackling acute form, the progress of the disease is more rapid and in its interstices. The perinseum is also boggy on pressing it. Pulse 80, tremulous, and rather weak; tongue dry and furred; dangerous, showing itself, in the first instance, under appa- bowels open. Incisions were made on each side of the raphe,, but ere hours have rently trifling circumstances; many elapsed also in the perinsæum. Ordered, linseed poultice, and fomenassuming the character of phlegmonous infiltration, and tations to the scrotum and perinasum. Solution of the acetate placing the life of the sufferer in the greatest jeopardy. It is’ of ammonia, one ounce and a half; sesquicarbonate of amseen in persons of intemperate and cachectic habits, who have monia, twenty-four grains; camphor mixture, six ounces, for been subjected to cold and wet, or to any depressing agent of the vital powers. In the earliest stage the patient com-_ a mixture; dose, two tablespoonfuls three times a day. 2nd.—Has passed a restless night; pulse 84, rather weak; plains of a sense of irritation in the situation of the rectum, when an erythema may be observed on the integuments of much serum has escaped. The medicines to be repeated, and these parts, which soon spreads over the neighbouring sur- ten grains of compound ipecacuanha powder at bedtime. 3rd.-The sloughing of the scrotum is extensive; foetor very faces, accompanied by constitutional disturbance; the redness extends along the perinseum, over the scrotum, penis, and1 great; pulse 84; he complains of much debility; bowels open. Ordered, disulphate of quinine, sixteen grains; diluent suleven to the inferior portion of the abdomen, committing,, acid, forty minims; water, half a pound, for a mixture; ravages in its course. Thus, in forty-eight hours, the’ phurictwo tablespoonfuls three times a day. Lotion of chloride perinæum becomes tumid and boggy to the touch, the penis dose, of soda to be applied; the compound ipecacuanha powder reto a with state of cedematous, amounting phymosis, superficial ulcerations, and the scrotum, the principal and worst peated. Diet to be nourishing. 4th.-Was called up last night for retention of urine; the * That is, death occurring, as in strangulation, from privation of oxygen, catheter passed with some difficulty; deeper incisions in the and while the nervous system and the circulation are in comparative vigour. perinseum were made; much foetid serosity escaped. Repeat, When death results from a gradual and simultaneous subsidence of all thee the medicines. vftl powers or organs, the lips, and often the eyes also, are closed, and the 5th.-Has passed a better night; pulse 82; sloughs beginning expression of the countenance tranquil, and even smiling-facts of some to loosen. Repeat the medicines. importance in medico-legal examinations.
genus, and of very nearly related species. Hemlock is a useful sedative. In gastrodynia it acts well combined with the tris-nitrate of bismuth, with nitrate of silver, and the oxide of zinc. In scirrhus and cancer of the pylorus, it is indicated, since while it relieves pain it does not constipate. I have seen it useful also in mesenteric affections of strumous children. In France, they combine it (and, I think, judiciously) with the iodide of iron and with quinine, in cases of scrofula. From one to ten pills, made from about half an ounce of extract of hemlock and one ounce of iodide of iron, are given daily in cases of scirrhous and scrofulous tumours, and in phthisis. In phlegmonous scirrhus, the hemlock is, in France, joined to extract of cinchona. Giacomini, in his celebrated classification, places conium among lymphatico-glandular hyposthenics, and also, from its reducent action on the contractions of the heart, among cardiaco-vascular hypothenics. Bentinck.street, Manchester-square.
same
’
’
,
.
.
f -
t _
360 6th.-Feels comfortable. Repeat the medicines. 8th.—The sloughs are loosening; complains of debility ; pulse 84 and weak. Repeat the medicines. 10th.-Much the same. 12th.—Sloughs have come away. Ordered, sulphate oi zinc lotion. The parts to be supported by a bandage. Appetite good, and is gaining strength. 15th.-Continues to improve. Lotion repeated. From this time, cicatrization took place rapidly.
session, is so diluted, that at the termination of his hospital studies he finds himself all abroad in the matters of The centrifugal power will be chemical decomposition, &c. supplied by this new edition of an old favourite: it is cor-
first
enlarged, to suit the march of improvement, which, during the last seven years, has been so distinctive of a. the English medical schools. When Mr. Meade-in his day very popular private teacher amongst the transpontine April 10th.—Discharged cured. students of the metropolis-originally published his Manual, CASE 2.—Jesse W-, aged fifty-five, by trade a sawyer; no student was required to " get up" the stethoscopic signs of admitted Dec. 27th, 1846 ; of plethoric habit; works hard; disease; microscopic anatomy was scarcely dreamed of; the has drank freely; and does not get nourishing food every of Liebig was unbegotten; and the countenance physiological chemistry Pulse and anxious; day. 78, easily compressed; that on the discoveries of Hall of States Marshall thirst. and unacknowledged. Much credit tongue dry; complains 23rd he was exposed to wet and cold during the day’s work. is due to the editor, for the great labour and care he has In the evening shivered much, and " felt uneasy about the bestowed upon this epitome of medical science; as the power On the following day, he anus, as if he had got piles." of is so fascinating and so natural to all authors, amplification much exertion. returned to his work, but was very unequal to On the 25th, Christmas day, he perceived a redness on the so is the conciseness and concentration shown in this Manual perinseum; kept himself quiet. On the 26th, worked in a the more praiseworthy. We would particularly specify the sawpit the principal part of the day; and in the evening was chapters on toxicology and the practice of physic; we can much worse. On the following day, Sunday, 27th, his wife them to be the concentrated notes of a very diligent called at my house with a letter for the dispensary. From imagine her description, my expectations were fully realized on student of the last session. The visceral anatomy is very visiting him. The scrotum was very cedematous, tense, shining, concisely given; but why omit all notice of the theory of the emphysematous to the touch, quite void of rugae, and of a reflex function ? Surely medical examiners will require their deep reddish hue; at the inferior and posterior parts, dark candidates to have some acquaintance with so important a ash-coloured spots were observable, about the size of a fourpart of physiology. The editor has behaved so well towards penny-piece. The perinæum unsound and boggy on being the stethoscope and the animal chemistry of Liebig, that we pressed; the penis cedematous, with superficial ulcerations, and in a state of phymosis. Incisions were made through regret to have to remind him of this unfortunate omission. the cellular membrane of the scrotum, also of the perinseum ; There is just room for complaint, too, concerning the physiohaemorrhage very slight; much infiltrated serum has escaped, logical chemistry-some two or three subjects remain untogether with foetid air. Ordered, linseed poultice and fomen- noticed, the theory of the formation of dew, &c. Whilst in tations to the parts. Infusion of cascarilla, seven ounces and this suggestive mood, induced by the general excellence of a half; sesquicarbonate of ammonia, twenty-four grains; tincthe work; we would hint at the propriety, when another ture of cardamoms, four drachms, for a mixture; dose, two edition is called for, of a formulary for the doses of medicines tablespoonfuls three times a day. 28th.-Has had no sleep; pulse 90; diarrhoea has been fre- in combination: they are, of course, given separately, but quent during the night; the exudation from the scrotum is students require to know the quantities of each medicine they very great, and extremely offensive. Ordered, chalk mixgive, when it is desirable to combine thef ction of two ture, six ounces; tincture of opium, forty drops, for a mixture; may or more. Diet dose, two tablespoonfuls every four hours. nourishing. We have taken these few exceptions, because the book 29th.-Has slept better last night; diarrhœa is somewhat is but feels the scrotum extenis a good one, and we should like to see it as perfect as very weak; abated, sloughing sively. The last mixture to be repeated. possible. 30th.—Diarrhœa has stopped. The chalk mixture to be omitted, and the cascarilla mixture to be resumed. Braithwaite’s Retrospect of Medicine. Vol. XIV. July31st.-The sloughing continues; pulse 80 ; complains of December, 1846. great debility. All the medicines to be repeated; they were continued onward to the 18th proximo. THE practitioner in medicine is much indebted to Mr. Jan. 1st.—Has passed a good night, and feels better. Braithwaite, for enabling him, without wading through the 2nd.-The sloughs are loosening; infiltrated serum very volunlinous articles of the Quarterlies, or the long speeches of abundant; foetor excessive; bowels regular. projectors and objectors at the various societies, to keep up 4th.-Is much the same. 6th.-A large portion of slough has loosened; he says he his information as to the progress of improvement in his profeels comfortable; pulse 78 and weak. fession. 8th.-Going on well. No man can look over this work without feeling proud of 10th.-Sloughs are coming away both in the scrotum and the profession to which he belongs, and of the men who ornaperinmum; he feels stronger, and sleeps well at night. , 13th.-The whole of the anterior integuments of the ment it. Here are 450 closely-printed pages of concentrated scrotum have sloughed away, leaving the testes quite denuded. information, touching upon 200 subjects, and we dare to affirm 16th.-A large slough in the perinæum has come away; that not half-a-dozen of those pages is without a highly practical suggestion. To reduce ingenuity and hypothesis to appetite good; in fact, could eat more than he gets. 18th.—Is going on well. Ordered, nitrate of silver, one is peculiar to our country, and in this work it ,is degrain; water, an ounce, for a lotion. Poultices to be omitted. practice to see how every new invention, or discovery, or lightful 22nd.-Continues to progress favourably. The parts to be is weighed as to its applicability to the relief of a suggestion, supported by bandage. 26th.-Going on well. Lotion repeated. This treatment the suffering patient. With this book in his hand no man was continued until Feb. 15th, when the scrotum and adjacent need be ignorant of the improvements of the day. We parts were healed. Discharged cured. scarcely know how to select, amongst the numerous articles Keppel-street, Russell-square, March, 1347. of interest, the most interesting. Perhaps the most novel, and the one most likely-should future experience prove its truth-to show itself of signal benefit to the physician in his Reviews. diagnosis, is Mr. Hutchinson’s, on the use of the spirometer. In a paper read before the Royal Medical and Chirurgical Meade’s Manualfor Students. Second Edition. London: Society, by Mr. Hutchinson, he speaks of the difference in the Renshaw. of air respectively drawn in or thrown out of the WE are not amongst those who think this class of books quantity as follows:lungs, injurious. There is a remarkable centrifugal force always 1. Residual air; which is that air remaining in the lungs cannot be expelled by the most violent muscular effort. acting on the student’s sensorium, by which the knowledge that " ’ he has acquired from lectures and large books, during the 2. Reserved air, or that which remains in the lungs after rected and
________
,
"
" ’