1846.] ENGLISH AND FRENCH MEDICAL PERIODICALS. 275 at critical appreciation of its merits or demerits; and he complacently thanks his stars there are none such in France. The refutation of this statement may be safely left to our readers; but we must observe that, did publications such as these really are exist in France, the profession of that country would much benefit by exchanging the present interminable and wearisome original articles often by obscure writers, (worked up with a display of elementary information, a pedantic magniloquence, and an affectation of definitively settling the matter that would be insufferable here,) which often encumber their journals for prompt, impartial, critical, and copious accounts of every native or foreign original work that appears. Moreover, is not the high position which this writer allows our medical journals assign in their columns to notices of the progress of medicine in France due to the cosmopolitan spirit which has ever actuated the British Medical Press, through whose agency every English practitioner is as familiar with the names and labours of the continental practitioners as he is with those of his own country. Were the same copious notices bestowed by the French medical press upon the various works which issue from this country, the utter ignorance respecting the progress of medical science in England, which at present not only generally prevails among their readers, but too often disgraces their writers, would surely be diminished. Again it is stated that the Lectures" published in the weekly periodicals are generally mere reprints of works which have already appeared! We should be curious to see the medical journal that would venture to publish such. Admitting that these lectures must necessarily be very unequal in value, every one knows that several of the courses originally so given to the world, have since been re-published (reversing the order stated by our friend,) and now form works of standard and sterling value. The names of Cooper, Abernethy, Clutterbuck, Lawrence, Latham, Liston, Brodie, Murphy, Conolly, Watson, &c., &c., &c., are surely guarantees that the perusal of such lectures will not be without ample profit. In fact, there is scarcely a man of any celebrity in London whose opinions have not been thus published. The writer is horror-struck at the great number of advertisements, quite unconnected with medicine, which are attached to several of our journals. The practice of advertising, like many others of equal utility, is very little developed in France, and therefore it is no-wise surprising that the medical periodicals do not largely participate in it. In England the advertisements are a separate concern from the professional portion of the journal, and their reception and arrangement does not devolve upon the editor, but upon the publisher-care being always taken that they do not intrench upon the specific space (in conscience large enough for the price) devoted to the proper object of the publication. Advertizers, aware that these publications circulate extensively among medical men, who often have little time for the perusal of those of a more general nature, and believing that the fact of a person pursuing a liberal profession does not exempt him from the ordinary wants of mankind, naturally take the opportunity of offering to his notice whatever they have to dispose of, and what there is reprehensible or ridiculous in this it would be difficult to discover. But we may safely assert, that if the advertisements are more numerous in London than in Paris, they are also more select; and that even the extra-professional pages of our medical journals will be never found disgraced, as are some of those of Paris, by advertisements of Morrison's Pills. Maisons d'Accouchement, Secret Pills, though approved by Academies; or by woodcuts of quack corsets, and women employing uterine irrigators, &c. One thing, which is noticed by this writer, we do certainly feel somewhat ashamed of, viz.; the eagerness with which young men who have passed a few seasons at Paris display the "slightest honorary grade there acquired, as if it were a most powerful recommendation on the other side of the Channel." We are not disposed to underrate the advantages of a visit to Paris: but we are so far from believing that a prolonged residence in that capital is an advantageous preliminary for an English practitioner, that we quite agree with our esteemed predecessor, the late Dr. Johnson, that the first thing persons so educated find on their return is, that they have as much to unlearn as to learn, before they can become safe and efficient practitioners. LIGATURE OF BOTH CAROTID ARTERIES FOR A REMARKABLE ERECTILE TUMOUR OF THE MOUTH, FACE, AND NECK. By J. MASON Warren, M.D. A man, æt. 23, presented himself to the author's notice, the left side of whose face, neck, and mouth was occupied by an enormous erectile tumour of four years' growth. The tongue has been swollen, and the lip occasionally ulcerated, during this period. This last now threatens to take on a cancerous degeneration, and this, together with the fear of fatal hæmorrhage occurring sooner or later, induced Dr. Warren to perform the operation. On the 5th Oct., 1845, the left carotid artery was tied. The patient was about in ten days, the tumour diminishing in size, and the ulcer healing rapidly-his health seeming perfect. Nov. 7th. The swelling still much diminished and paler. The right carotid was now tied, with no other inconvenience to the patient than drowsiness, and faintness on raising the head. Nov. 29th. Ulceration of the lip had healed, but as it continued thick and everted by the erectile tissue, it was deemed advisable to remove the diseased portion by a V-like incision, the slight hæmorrhage which attended this operation being easily controlled. Dec. 12th. The discolouration of the face has become much paler, and the ear resumed its natural size. No pulsation can be felt in the temporal arteries. Just above the clavicle two arteries, nearly the size of the carotids, are seen pulsating powerfully under the skin. Feb. 1st. Patient is in perfect health, and has not had the slightest indications of disturbance in the brain from this interruption of its natural circulation.—Amer. Journ. Med. Soc., April. ON THE GRANULAR DISEASE OF THE PHARYNX. By M. CHOMEL. During a year or so that M. Chomel's attention has been directed to this affection he has seen, or collected accounts of, about 30 cases. Of these, none has been observed in persons younger than 15. Of 22 cases occurring in his own practice, 17 were males, most of them (like women subject to uterine granulations) being also liable to herpetic eruptions, and especially to acne. In most there is also a peculiar form of the palatine arch, narrowing the nasal fossæ, and contracting the lips, so that these are never completely closed. Such persons sleep with the mouth half open, and awake with it in a very dry state, the pharyngeal follicles becoming, under these circumstances, excessively developed, in consequence of the constant evaporation of the buccal fluids produced by this contact with the air. Thus, also, the persons in whom the complaint is most frequently met with, are those who employ their vocal organs considerably, as orators, singers, advocates, professors, &c. The affection usually comes on slowly, and excites little uneasiness at first, save from the constant hawking it gives rise to. This sometimes becomes quite sonorous, and is accompanied by involuntary attempts at deglutition, and if the irritation is propagated to the esophagus, a frequent desire to drink. There is a dryness or itching in the pharynx, and the voice is more or less affected. The expectoration consists of transparent viscous globules of a slight opaque tinge, 1846.] ON PARACENTESIS THORACIS. 277 or streaked black or slate colour. On examination, we find the pharynx covered with little red points the size of hemp-seed, but sometimes being much more voluminous. They may be grouped into arabesque-like forms, into little discs, or as nipple-shaped projections. Granules are also usually found upon the palate and uvula, but then they are more discrete. The mucous membrane retains its normal characters. The course of the disease is always chronic and remitting, it being especially troublesome in cold and damp weather. It never spontaneously disappears, and often obstinately resists treatment. Of 14 cases which M. C. had occasion to see at more or less remote periods after treatment but 4 remained cured, the others being only relieved. The diagnosis of the affection is easy enough, as it obviously consists in hypertrophy of the numerous muciparous follicles of the pharynx. In treating the disease, M. Chomel has tried all descriptions of astringent gargles, &c., with but indifferent success, and when it proves obstinate, cauterizing the mucous membrane is the only means likely to prove serviceable, fluid caustics having been found more useful in his hands than solid ones.Gazette Médicale, No. 16. ON PARACENTESIS THORACIS IN ACUTE PLEURITIC EFFUSION. In reporting upon an additional account of this operation, recently presented to the Académie by M. Trousseau, M. Bricheteau adverts to the fluctuations of opinion which have occurred in reference to it, as applied to empyema, in both ancient and modern times. In was in 1841 M. Trousseau adduced two or three successful instances of its application to cases of recent pleuritic effusion, and in the present paper another is brought forward. The patient, æt. 24, had suffered from pleurisy about 20 days prior to admission. The side was notably dilated, and the effusion not yielding, a puncture was practised between the 7th and 8th ribs, and about 70 oz. of a clear fluid discharged with manifest relief, the patient being dismissed in about a fortnight afterwards. She has been since seen by M. Bricheteau, who found her cure confirmed. Two other successful cases have occurred since this paper was presented, the particulars of which are furnished by M. Bricheteau. In considering whether M. Trousseau's success is such as to warrant the recommendation of the imitation of his practice by the Académie, M. B. observes, we must bear in mind that, even in the last century, when our diagnosis was so much more uncertain, examples of cure by this means were by no means rare. MM. Monneret and Fleury state that, of 66 instances in which we have accounts of its having been performed, in 56 the effusion was the result of pleuritic inflammation, and that of these 42 were cured and 14 died. M. Trousseau believes that we should not wait until the dyspnoea become very urgent and suffocation impending, as danger may exist, if the fluid have gradually accumulated, long before this. If the dulness upon percussion be perceived along the median line, as low as the 4th rib, the puncture may be made, although the dyspnoea be not urgent; while, if it extend daily across the median line, towards the opposite side, the necessity for interfering is still more apparent, especially if the effusion be on the left side, and tends to displace the heart towards the right. If, even when the dulness does not extend beyond the median line, there is orthopnoea, a small frequent pulse, anxious countenance, and especially any tendency to lithopymia, we should operate at once. M. Trousseau prefers evacuating all the fluid at one operation, and guards against the admission of air (by disposing a piece of gold beaters' skin as a valve over the orifice of the canula,) which might oppose the re-distension of the pulmonary structure in its now enlarged cavity. The difficulty with which a condensed lung re-expands is far less in recent than in chronic pleuritic effusion, as firm adhesions have not formed, and the elasticity of its texture is not yet destroyed. In M. T.'s cases, the Reporter ascertained that the air penetrated immediately into every portion of the pulmonary structure. The existence of pulmonary tubercle is not an absolute objection to the operation, as the removal of fluid in this case has sometimes at least prolonged life.-Gaz. Méd. Chir., Nos. 17 and 18. (In the brief discussion which followed, M. Louis observed that, he thought the operation should be more cautiously recommended. He had seen many cases of pleurisy, but none in which it appeared indicated; nor had he ever met with a case which terminated fatally when the disease was in its simple form. M. Rochoux stated that, although cases in which this operation could be called for must be very rare, that yet they may occur, and that more frequently in acute than chronic pleurisy. M. Bricheteau agreed in this last opinion. We believe with the above practitioners that, the necessity of an operation in simple pleurisy, properly treated, can never hardly occur: but the case is very different in more complicated instances, and in even simple ones which have been neglected. In such we doubt not of its propriety, and see no reason to hesitate about its performance. The extension of the operation has in this country met with many advocates of late, and we may refer among others to the papers of Drs. Hughes and Roe, in the Guy's Hosp. Rep. and Medico-Chir. Trans.-See Med. Chir. Rev., N. S. Vol. I.-Rev.) MANAGEMENT OF THE PUERPERAL STATE. In M. Piorry's ward at La Pitié are women suffering from fever producing eschars on the sacrum, and others brought from the Maternité labouring under puerperal peritonitis, and yet, although the ceiling is low and the beds crowded, no instance of phlebitis, phlegmasia dolens, or peritonitis, putting on the dangerous character so common in the puerperal state, has ever been observed among the women delivered therein during the ten years he has had charge of it. In this same ward five women have been brought from a maison d'accouchement suffering from utero-peritonitis, and of these three died. At the Maternité the mortality has been such as to lead to the distribution of the remaining patients among the other hospitals. M. Piorry, regarding any ill effects which may result from the admission of cold air as minor evils, has all the windows, however, near the beds, kept wide open and the bed-curtains drawn back, taking care, however, that the woman's exposed person do not become subjected to the currents. Immediately after delivery, he orders the vagina to be carefully injected with tepid water every hour or two. He has the abdomen rubbed with olive oil, orders good diet, and keeps the bowels open with aperients and enemata. He thinks lying-in women should be admitted into the general hospitals, and not congregated together in special ones.—Gaz. des Hôpitaux, No. 43. ON THE PUBLIC HEALTH OF PARIS DURING THE FIRST QUARTER OF 1846. The Gazette Médicale has recently published some interesting articles upon this point. From the Registries of the Paris Observatory, it appears that-1. The temperature was unusually high. 2. The atmospheric pressure more considerable 1846.] PUBLIC HEALTH OF PARIS. 279 than ordinary. 3. A remarkably small quantity of rain fell in February. 4. South and west winds predominated. 5. The oscillations of the thermometer and barometer were neither considerable nor sudden. 6. All the above characteristics were more marked in February than in the other two months. The diseases of the quarter may be considered in reference to their form, seve rity and frequency. 1. As regards the form, the most remarkable thing was the rarily of the acute affections of the respiratory organs usually met with in winter -bronchial catarrh itself being even far from common. Even those which did present themselves were very mild, sometimes assuming rather a neuralgic than an inflammatory character. The diseases commonly met with in summer and autumn were on the other hand frequent. Thus gastric and bilious fevers were very prevalent, and what is still more uncommon at this season several cases of typhoid fever, generally of an ataxic form, occurred. Others of a rare disease at Paris, remittent fever, were met with, the adynamic form prevailing. In Febru ary and March puerperal fevers abounded, women who were not pregnant or puerperal, and others who had been confined for a fortnight or so, suffering at the same period from induration of cellular tissue of the pelvis, and pains in the renal and abdominal regions. Finally, a malignant and fatal form of measles prevailed. Adynamia and ataxia formed the common character of these various affections. In fact, the season of the quarter from January to April resembled that of summer and autumn combined. To a very unusual and little changing elevation of temperature, were conjoined on the one hand southerly and westerly winds, and on the other, in January and March, considerable falls of rain and the simultaneous inversion of the medical and atmospheric constitutions is remarkable. Medical constitutions do not, however, depend upon the absolute quantity of heat or moisture; and a given atmospheric condition will produce different effects according to the epoch of the year at which it is observed. Thus, the temperature during which these affections appeared was far less elevated than that which is observed at the time of their prevalence in summer. 2. The frequency of disease, as exhibited by the number of admissions into the hospitals was increased; for, while these amounted to but 18,807 in the first quarter of 1845, when the weather was much colder from northerly winds, and the atmospheric perturbations much more considerable, they reached 19,846 in the quarter of 1846. Diseases put on different forms then, but increased in number. In examining their distribution over different months, one is struck with the comparative immunity of February, during which there were 300 patients less than in January, and 850 less than in March. Of all the atmospheric conditions the quantity of rain alone considerably differed in this month. The total quantity of rain which fell during the first quarter of 1845 was less considerable than that which fell during the same period of 1846 in the proportions of 12.060 to 15 067. In both years, too, the amount which fell in February was considerably less than that which fell in the other two months of the quarter, and the number of admissions diminished in like proportion. 3. The severity of the diseases can only be imperfectly estimated by the number of discharges from the hospitals. From these, however, their benign character may to some extent be inferred-since of a hospital population of 37,056 in the quarter of 1846, there were 18,213 discharges; while of a population of 36,043 in 1815, there were but 16,695. The generally mild character of prevalent affections does not however necessarily imply a small proportion of deaths. In this ataxic constitution the majority of the patients do not exhibit alarming symptoms, but amid apparent security diseases from time to time put on unusual and unexpected fatal characters. Thus, in spite of the large number of dismissals that of the deaths was yet greater than in 1845. In that year, of 36,043 patients 1958 (1 in 18·4) died, while the deaths of 1846 were 2073 in 37,056 patients (1 in 18-1.)—Gazette Médicale, Nos. 18, 19, 20. |